A prospective study on urinary microalbuminuria as surrogate marker of vascular endothelial dysfunction, in patients of ischemic stroke
DOI:
https://doi.org/10.18203/2349-3933.ijam20172271Keywords:
Creatinine clearance, MicroalbuminuriaAbstract
Background: Presence of overt proteinuria has been independently linked to greater stroke risk. The objectives of this study were to determine the relationship between the for ischemic stroke and albuminurea as a marker for vascular events. Microalbuminuria, is an early marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and relationship between microalbuminuria and incident ischemic stroke has not been clearly defined. The purpose of this study was to assess the association of microalbuminuria and ischemic stroke.
Methods: Study enrolled 150 admitted patients of acute ischemic stroke. The patients were assessed by questionnaire, microalbuminuria, creatinine clearance after detailed history taking and thorough clinical examination.
Results: The combined common risk factors were HTN (80%), diabetes (33%) and smoking (53%). The hypertensive patients had 8 times higher risk of microalbuminuria as compared to normotensive patients (95% 1.8-31.0 p<0.05). Among diabetes patients had risk of microalbuminuria 30 times higher compared to euglycemic patients (95% CL 9.6-78.8 p<0.01). The smoker patients had 8 times risk of microalbuminuria (CL 95%-1.2-22.8 p<0.16). However, the patients who had dyslipidemia had risk of microalbuminuria 1.07 times who have normal lipid level, but it was statistically insignificance (98% CL 0.8-4.1 p>0.05). The 38 patients out of 46 patients who had microalbuminuria has high normal serum creatinine with creatinine clearance (45-59 mL/min/1.73 m2. (82% versus. 4.4% 30.44 mL/min/173m2). The risk of microalbuminuria was higher in patients who had high normal serum creatinine (1.4 mg/dL) with creatinine clearance of 45-59 mL/min/1.73 m2 versus normal serum creatinine 0.8 mg/dL.
Conclusions: The finding of the study, show the microalbuminuria is an independent risk factor for vascular endothelial dysfunction, in patient of diabetes early renal dysfunction and HTN, extrapolating the vascular event (ischemic stroke).
References
Ninomiya T, Perkovic V, Verdon C, Barzi F, Cass A, Gallogher M, et al. Proteinuria and stroke; meta-analysis of cohort studies. Am J Kidney Dis. 2009:53:417-25.
Ovbiagale B. Microalbuminuria; risk factor and potential therapeutic target for stroke. J Neuro Sci. 2008:271:21-8.
Halini JM, Farhan A, Balkau B, Novak M, Wilpart E, Tichet J, et al. Is microalbuminuria an integrated risk marker for cardiovascular disease and insulin resistance in both men and women. J Cardio Risk. 2001:8:139-46.
Mathur PC, Punekar P, Muralidharan R. Microalbuminuria in non-diabetic acute ischemic stroke an Indian perspective. Ann Ind Acad Neurol. 2005:8:237-42.
Nakayoma T, Date C, Yokoyama T, Yashika N, Yamoguchi M, Tanaka H. A 55 year follow-up study of stroke in Japanese provincial city; the Shibata study. Stroke. 1997:28:45-52.
Mykkanen L, Zaccaro DJ, Leary DH, Howard G, Robbin DC, Haffner SM. Microalbuminuria and carotid intima-media thickness in non-diabetic and NIDDM subject; The insulin resistance atherosclerosis study (IRAS). Stroke. 1997:28:1710-6.
Montalecost G, Colleat J. Preserving cardiac function in the hypertensive patients why renal parameter hold the key. Euro Heart J. 2005:26:2616-22.
Donnelly R, Yeung JM, Manning G. Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type II diabetes. J Hyper Sup. 2003:21(1);57-62.
Naidoo DP. The link between microalbuminuria endothelial dysfunction and cardiovascular disease in diabetes. Cardio J South Africa. 2002:13:194-9.
Valmadrid CT, Klein K, Mols F, Klein BEK. The risk of cardiovascular disease mortality associated with microalbuminuria and cross proteinuria in person with older onset diabetes mellitus. Arch Intern Med. 2000:160:1093-100.
Afsar B, Elasrer B. The independent relationship between creatinine clearance, microalbuminuria and circadian blood pressure in newly diagnosed essential hypertension and type II diabetic patients. J Diabet Comp. 2012;26(6):531-5.
Bargman JM, Skorecki K. Harrison: Principle of internal medicine. 2015;2:1812-3.
Hiltege HL, Janseen WM, De Jong P. Microalbumuria is common also in non-diabetic, non-hypertensive population and independent indicator of cardiovascular risk factor and cardiovascular mortality. J Intern Med. 2001;249:519-26.
Horner D, Hisher D, Ritz E. Albuminuria in normotensive and hypertensive individual attending office of general practitioner. J HTN. 1996;14:655-60.
Gerstein HC, Man JF, Pogue J, Young J, Dinnen SF, Yusuf S. Prevalence and determinant of microalbuminuria in high risk diabetes and non-DM patients in heart outcome preventive evaluation study. The HOPE study investigator. Diabet Care. 2000;23 (sup 2):B35-B39.
Nakayama T, Dale C, Yokoyama T, Yoshika N, Yamaguchi M, Tanaka H. 15.5 year follow-up: study of stroke in Japanese provincial study. The Sobita Stroke. 1997;28;45-52.
Miettien H, Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso. Proteinuria predict vascular diseases event in non-diabetic and non-insulin diabetic subject. Stroke. 1996;27;2033-9.
Nent MYKK, Zaccaro DJ, O’Leary DH, Howard G, Robbin GC, Haffner SM. Microalbumuria and carotid artery intima media thickness in non-DM and NIDDM subjects; The insulin resistance atherosclerosis study (IRAS). Stroke. 1997;28;1710-6.
Yu Yun MF, Khaw KT, Luben R, Welch A, Bingham S, Day WE, et al. Microalbumuria and stroke in British population the Europeanprospective. Investigation into cancer in Norfolk (Epic-Norfolk) population study. J Intern Med. 2004;255:247-56.
Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease effect on cardiovascular system. Circulat. 2007;116;85-97.
Roguer J, Segura T, Serena J, Castillo J. Endothelial dysfunction, vascular diseases and stroke; the ARTICO study. Cerebrovascular Dis. 2009;8;27(sup 1);25-37.
Deckert T, Feldt-Rasmussen B, Borch-Johnson K, Jenson T, Envoldsen K. Albuminuria reflect wide spread vascular damage; The steno hypothesis. Diabetol. 1989;32:219-26.
