title: Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors.
abstract: BACKGROUND
  It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke.
  
  
  METHODS
  We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (<60 mL/min/1.73 m2, n = 128) and controls (eGFR ≥60 mL/min/1.73 m2, n = 128). The presence of SVD was evaluated according to magnetic resonance imaging performed on admission. Mortality data were obtained from medical chart reviews and telephone interviews.
  
  
  RESULTS
  Patients with silent lacunar infarction, WML, or microbleed had lower eGFR than patients without such lesions (60.4 ± 34.8 versus 87.5 ± 28.4 mL/min/1.73 m2, 60.5 ± 37.1 versus 73.9 ± 33.3 mL/min/1.73 m2, and 57.6 ± 33.3 versus 73.9 ± 32.9 mL/min/1.73 m2, respectively). In addition, the multivariate adjusted odds ratio for the presence of SVD increased inversely with eGFR. Three-year survival was lower in patients with renal dysfunction and each type of SVD. The presence of WML was an independent risk factor for cardiovascular death.
  
  
  CONCLUSIONS
  Renal impairment was associated with the presence of SVD in acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival.
authors: Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jae Woong
authors: JW
authors: Jeon
authors: Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea. Electronic address: hyuuu28@cnuh.co.kr.
authors: Hye Seon
authors: HS
authors: Jeong
authors: Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea. Electronic address: daenii@cnu.ac.kr.
authors: Dae Eun
authors: DE
authors: Choi
authors: Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Young Rok
authors: YR
authors: Ham
authors: Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Ki Ryang
authors: KR
authors: Na
authors: Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Kang Wook
authors: KW
authors: Lee
authors: Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jong Wook
authors: JW
authors: Shin
authors: Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors: Jei
authors: J
authors: Kim
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Chronic renal disease; cerebral small-vessel disease; mortality; stroke