title: Urinary albumin-to-creatinine ratio is associated with white matter lesions severity in first-ever stroke patients.
abstract: BACKGROUND
  The presence of white matter lesions (WML) is an indicator of small vessel disease; however, the underlying pathological mechanisms are still unclear. We aimed to investigate the association of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) with WML severity in first-ever stroke patients.
  
  
  METHODS
  We retrospectively enrolled 284 consecutive patients (177 male; median age 72years) admitted to our stroke center between May 2010 and January 2012. eGFR and UACR measurements were performed on admission. WML severity was assessed using the Fazekas classification. Severe WML was defined as a Fazekas grade of 2 or higher. The impact of eGFR and UACR on severe WML was evaluated using multiple logistic regression analysis.
  
  
  RESULTS
  Age (P<0.0001), sex (P=0.0094), eGFR (P=0.0173), UACR (P=0.0001), hypertension (P=0.0436), and brain natriuretic peptide (P=0.0354) were significantly associated with severe WML. On multivariable logistic regression analysis, high UACR (≥39.6mg/g creatinine, P=0.039), but not low eGFR (≤74ml/min/1.73m2, P=0.3672), was independently associated with severe WML. Comparisons between the UACR levels showed that severe WML was more frequent in the UACR ≥300mg/g creatinine group than in the UACR <30.0mg/g creatinine group after multivariate adjustment (OR, 2.25; 95% CI, 1.04-5.00; P=0.039). However, there was no significant association between eGFR and severe WML.
  
  
  CONCLUSIONS
  Our data suggest that high UACR, but not eGFR, is independently associated with severe WML.
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan. Electronic address: suda-sa@nms.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suda
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Kanamaru
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Okubo
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimoyama
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Chikako
authors.initials: C
authors.lastname: Nito
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Ishiwata
authors.affiliation: Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria; D015415:Biomarkers / Q000652:urine; D001921:Brain / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000652:urine*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000652:urine; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000652:urine*; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: Albuminuria; Estimated glomerular filtration rate; Small vessel disease; White matter lesions