Korean J Fam Pract. 2018; 8(6): 820-825  https://doi.org/10.21215/kjfp.2018.8.6.820
Effect of Albuminuria on Silent Lacunar Infarction
Hyung Jun Park1, Hyung-Min Kwon2, Jae-Sung Lim3, Sang Hyuck Kim4,5,*, Jin-Ho Park1,*
1Department of Family Medicine, Seoul National University Hospital; 2Department of Neurology, SMG-SNU Boramae Medical Center, Seoul; 3Department of Neurology, Hallym University Sacred Heart Hospital, Anyang; 4Health Screening and Promotion Center, 5Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Jin-Ho Park
Tel: +82-2-2072-0865, Fax: +82-2-766-3276
E-mail: kkolzzi0@gmail.com
ORCID: http://orcid.org/0000-0002-3942-6813
Sang Hyuck Kim
Tel: +82-31-787-7808, Fax: +82-31-787-4834
E-mail: fromage5@naver.com
ORCID: http://orcid.org/0000-0002-4851-396X
Received: August 18, 2017; Revised: September 22, 2017; Accepted: October 7, 2017; Published online: December 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Silent lacunar infarction (SLI) is a risk factor for progression to overt cerebrovascular disease (CVD). Albuminuria is used for the evaluation of renal dysfunction. Some studies showed an association between cerebral microbleeding and renal dysfunction, but the results were inconsistent. Therefore, this study aimed to examine the association between albuminuria and SLI.
Methods: A total of 2,211 subjects without overt CVD who underwent brain magnetic resonance imaging were analyzed in the health screening data of Seoul National University Hospital. SLI was defined as 3?5 mm area of focal subcortical infarction. Albuminuria was defined as a urine albumin-tocreatinine ratio ≥30 mg/g. Multivariate logistic regression analysis was performed.
Results: Albuminuria is associated with increased risk of SLI (adjusted odds ratio, 1.78; 95% confidence interval, 1.12?2.82). Variables associated with SLI included age (adjusted odds ratio, 1.08; 95% confidence interval, 1.06?1.11) and hypertension (adjusted odds ratio, 1.66; 95% confidence interval, 1.20?2.31).
Conclusion: The findings suggest that patients with albuminuria should be considered for CVD risk evaluation and screening.
Keywords: Cerebrovascular Disorders; Stroke, Lacunar; Albuminuria; Hypertension; Aged
References
  1. Korean Centers for Disease Control. Korea health statistics 2013: Korea National Health and Nutrition Examination Survey. Cheongju: Korean Centers for Disease Control; 2014.
  2. Baumgarten M, Gehr T. Chronic kidney disease: detection and evaluation. Am Fam Physician 2011; 84: 1138-48.
    Pubmed
  3. Molino D, De Lucia D, Gaspare De Santo N. Coagulation disorders in uremia. Semin Nephrol 2006; 26: 46-51.
    Pubmed CrossRef
  4. Ambühl PM, Wüthrich RP, Korte W, Schmid L, Krapf R. Plasma hypercoagulability in haemodialysis patients: impact of dialysis and anticoagulation. Nephrol Dial Transplant 1997; 12: 2355-64.
    Pubmed CrossRef
  5. Kamouchi M. Stroke features and management in patients with chronic kidney disease. Contrib Nephrol 2013; 179: 92-9.
    Pubmed CrossRef
  6. Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation 2007; 116: 85-97.
    Pubmed CrossRef
  7. Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-100.
    Pubmed CrossRef
  8. Sandsmark DK, Messé SR, Zhang X, Roy J, Nessel L, Lee Hamm L, et al. Proteinuria, but not eGFR, predicts stroke risk in chronic kidney disease:Chronic Renal Insufficiency Cohort Study. Stroke 2015; 46: 2075-80.
    Pubmed KoreaMed CrossRef
  9. Hemmelgarn BR, Manns BJ, Lloyd A, James MT, Klarenbach S, Quinn RR, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA 2010; 303: 423-9.
    Pubmed CrossRef
  10. Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982; 32: 8716.
    CrossRef
  11. Vermeer SE, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MM. Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 2002; 33: 21-5.
    Pubmed CrossRef
  12. Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM. Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke 2003; 34: 1126-9.
    Pubmed CrossRef
  13. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007; 6: 611-9.
    CrossRef
  14. O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 2005; 46: 200-4.
    Pubmed CrossRef
  15. Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int 2003; 64: 610-5.
    Pubmed CrossRef
  16. Cho AH, Lee SB, Han SJ, Shon YM, Yang DW, Kim BS. Impaired kidney function and cerebral microbleeds in patients with acute ischemic stroke. Neurology 2009; 73: 1645-8.
    Pubmed CrossRef
  17. Committee for the Korean Guidelines for the Management of Dyslipidemia. 2015 Korean guidelines for the management of dyslipidemia: executive summary (english translation). Korean Circ J 2016; 46: 275-306.
    Pubmed KoreaMed CrossRef
  18. KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007;49(2 Suppl 2): S12-154.
    Pubmed CrossRef
  19. Lamb EJ, MacKenzie F, Stevens PE. How should proteinuria be detected and measured? Ann Clin Biochem 2009; 46: 205-17.
    Pubmed CrossRef
  20. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol 2013; 12: 822-38.
    CrossRef
  21. Akoudad S, Sedaghat S, Hofman A, Koudstaal PJ, van der Lugt A, Ikram MA, et al. Kidney function and cerebral small vessel disease in the general population. Int J Stroke 2015; 10: 603-8.
    Pubmed CrossRef
  22. Kim SH, Shin DW, Yun JM, Lee JE, Lim JS, Cho BL, et al. Kidney dysfunc tion and cerebral microbleeds in neurologically healthy adults. PLoS One 2017; 12: e0172210.
    Pubmed KoreaMed CrossRef
  23. Vogels SC, Emmelot-Vonk MH, Verhaar HJ, Koek HL. The association of chronic kidney disease with brain lesions on MRI or CT: a systematic review. Maturitas 2012; 71: 331-6.
    Pubmed CrossRef
  24. Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B, et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003; 34: 1203-6.
    Pubmed CrossRef
  25. Perry HM Jr, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA 2000; 284: 465-71.
    CrossRef
  26. Bokura H, Kobayashi S, Yamaguchi S, Iijima K, Nagai A, Toyoda G, et al. Silent brain infarction and subcortical white matter lesions increase the risk of stroke and mortality: a prospective cohort study. J Stroke Cerebrovasc Dis 2006; 15: 57-63.
    Pubmed CrossRef
  27. Wada M, Nagasawa H, Kurita K, Koyama S, Arawaka S, Kawanami T, et al. Microalbuminuria is a risk factor for cerebral small vessel disease in communitybased elderly subjects. J Neurol Sci 2007; 255: 27-34.
    Pubmed CrossRef

This Article


Author ORCID Information

Services
Social Network Service

e-submission

Archives