Department of Nephrology, Yamagata City Hospital Saiseikan, Yamagata, Japan.
Clin Exp Nephrol. 2012 Aug;16(4):564-9. doi: 10.1007/s10157-012-0594-6.
Kidney disease is a known risk factor for stroke. This study investigated the relationship between kidney damage and stroke types.
A total of 525 incident stroke patients were registered and followed for 1 year. The prevalence of kidney damage [proteinuria and/or renal insufficiency (estimated glomerular filtration rate<60 ml/min/1.73 m(2))] in incident stroke and its effects on 1-year prognosis were examined.
Among all stroke patients, kidney damage and its component (proteinuria and renal insufficiency) were commonly observed (48.2, 25.5, and 33.9%, respectively). The prevalence of ischemic stroke was significantly higher in patients with kidney damage (75.9%) than in those without (58.9%). The most frequent type of stroke among all patients with kidney damage and renal insufficiency only was cardioembolic infarction. In contrast, in patients with proteinuria only and patients without kidney damage, the most frequent type was subcortical and subarachnoid hemorrhage, respectively. Multiple logistic regression analysis showed that kidney damage or the combination of its components were independently associated with 1-year death [odds ratio (OR) 3.04, 95% confidence interval (CI) 1.40–6.59, P = 0.005 for kidney damage, OR 2.82, 95% CI 1.05–7.58, P = 0.040 for proteinuria only, and OR 5.77, 95% CI 2.23–15.0, P<0.001 for both proteinuria and renal insufficiency]. In addition, for 1-year outcomes, there were selective associations between ischemic stroke and proteinuria and between hemorrhagic stroke and renal insufficiency.
This study shows that kidney damage is common in Japanese stroke patients, and proteinuria and renal insufficiency are differentially related to development and prognosis, depending stroke types.
肾脏疾病是中风的已知危险因素。本研究调查了肾脏损伤与中风类型之间的关系。
共登记了 525 例首发中风患者，并进行了 1 年的随访。检查了首发中风患者中肾脏损伤（蛋白尿和/或肾功能不全（估算肾小球滤过率<60 ml/min/1.73 m2））的患病率及其对 1 年预后的影响。
在所有中风患者中，肾脏损伤及其成分（蛋白尿和肾功能不全）很常见（分别为 48.2%、25.5%和 33.9%）。有肾脏损伤的患者中缺血性中风的患病率明显高于无肾脏损伤的患者（75.9% vs. 58.9%）。所有有肾脏损伤和肾功能不全的患者中最常见的中风类型是心源性脑梗死。相比之下，在仅有蛋白尿和无肾脏损伤的患者中，最常见的类型分别是皮质下和蛛网膜下腔出血。多因素逻辑回归分析显示，肾脏损伤或其成分的组合与 1 年死亡独立相关[优势比（OR）3.04，95%置信区间（CI）1.40-6.59，P = 0.005 对于肾脏损伤，OR 2.82，95%CI 1.05-7.58，P = 0.040 对于仅蛋白尿，OR 5.77，95%CI 2.23-15.0，P<0.001 对于蛋白尿和肾功能不全均有]。此外，对于 1 年结局，缺血性中风与蛋白尿之间以及出血性中风与肾功能不全之间存在选择性关联。
本研究表明，肾脏损伤在日本中风患者中很常见，蛋白尿和肾功能不全与不同类型的中风的发生和预后相关。
