8
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Acute ischemic stroke associated with nephrotic syndrome: Incidence and significance — Retrospective cohort study

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          We report 10 cases with arterial ischemic stroke (AIS) with nephrotic syndrome (NS), and clarified its incidence and clinical characteristics. The patients having albumin less than 3.0 g/dl and serum cholesterol greater than 250 mg/dl at the same time were retrospectively screened from 11,161 cases of stroke. Furthermore, the patients of AIS showing heavy proteinuria were selected. The 10 cases were diagnosed as AIS with NS. Its incidence was 0.09% of all kinds of stroke and 0.12% of AIS. Their subtypes were 6 large-artery atherosclerosis, 3 small-vessel occlusion, and 1 cardioembolism. We carried out a retrospective cohort study to assess the association between NS and atherosclerosis progression in AIS patients. Seven AIS patients with NS due to diabetic nephropathy (cases; NS group) were compared with patients with AIS and diabetes mellitus (DM) without NS (control group). Control group subjects were matched in a 2:1 ratio to cases by age, sex, use of medications for DM, and hemoglobin A1c (HbA1c) level. The NS group had high cerebral artery atherosclerosis scores, especially in the anterior circulation. The NS group demonstrated atherosclerosis of the internal carotid and lower extremity arteries, although there were no statistical differences between the two groups. Study subjects had high serum fibrinogen and D-dimer levels, suggesting that AIS patients with NS have a greater degree of hypercoagulability than AIS patients without NS.

          Highlights

          • We report 10 cases with arterial ischemic stroke (AIS) with nephrotic syndrome (NS).

          • The incidence AIS with NS was clarified.

          • By a retrospective cohort study, AIS with NS showed atherosclerosis progression comparing the controls.

          • AIS patients with NS have a greater degree of hypercoagulability than AIS patients without NS.

          Related collections

          Most cited references28

          • Record: found
          • Abstract: found
          • Article: not found

          Cerebral venous thrombosis: an update.

          Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular disease that can occur at any age, including in neonates, and it accounts for 0.5% of all stroke. The widespread use of neuroimaging now allows for early diagnosis and has completely modified our knowledge on this disorder. CVT is more common than previously thought and it is recognised as a non-septic disorder with a wide spectrum of clinical presentations, numerous causes, and usually a favourable outcome with a low mortality rate. MRI with T1, T2, fluid-attenuated inversion recovery, and T2* sequences combined with magnetic resonance angiography are the best diagnostic methods. D-dimer concentrations are raised in most patients but normal D-dimers do not rule out CVT, particularly in patients who present with isolated headache. Heparin is the first-line treatment, but in a few cases more aggressive treatments, such as local intravenous thrombolysis, mechanical thrombectomy, and decompressive hemicraniectomy, may be required.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study.

              No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of VTE and ATE in a large, single-center, retrospective cohort study and attempted to identify predictive factors in these patients. A total of 298 consecutive patients with nephrotic syndrome (59% men; mean age, 42+/-18 years) were enrolled. Mean follow-up was 10+/-9 years. Nephrotic syndrome was defined by proteinuria > or =3.5 g/d, and patients were classified according to underlying histological lesions accounting for nephrotic syndrome. Objectively verified symptomatic thromboembolic events were the primary study outcome. Annual incidences of VTE and ATE were 1.02% (95% confidence interval, 0.68 to 1.46) and 1.48% (95% confidence interval, 1.07 to 1.99), respectively. Over the first 6 months of follow-up, these rates were 9.85% and 5.52%, respectively. Proteinuria and serum albumin levels tended to be related to VTE; however, only the predictive value of the ratio of proteinuria to serum albumin was significant (hazard ratio, 5.6; 95% confidence interval, 1.2 to 26.2; P=0.03). In contrast, neither the degree of proteinuria nor serum albumin levels were related to ATE. Sex, age, hypertension, diabetes, smoking, prior ATE, and estimated glomerular filtration rate predicted ATE (P< or =0.02). This study verifies high absolute risks of symptomatic VTE and ATE that were remarkably elevated within the first 6 months. Whereas the ratio of proteinuria to serum albumin predicted VTE, estimated glomerular filtration rate and multiple classic risk factors for atherosclerosis were predictors of ATE.
                Bookmark

                Author and article information

                Contributors
                Journal
                eNeurologicalSci
                eNeurologicalSci
                eNeurologicalSci
                Elsevier
                2405-6502
                22 October 2015
                Sep-Dec 2015
                22 October 2015
                : 1
                : 3-4
                : 47-50
                Affiliations
                [a ]Brain Attack Center Ota Memorial Hospital, Department of Neurology, 3-6-28 Okinogami, Fukuyama, Hiroshima 720-0825, Japan
                [b ]Department Radiology, 3-6-28 Okinogami, Fukuyama, Hiroshima 720-0825, Japan
                [c ]Department of Neurology and Clinical Pharmacology, Ehime University Graduate School of Medicine, Japan
                Author notes
                [* ]Corresponding author. kuriyama@ 123456shouwa.or.jp
                [1]

                Present address: Department of Neurology, Oita Red Cross Hospital, Japan.

                Article
                S2405-6502(15)00012-X
                10.1016/j.ensci.2015.10.002
                5822043
                bc36a915-6aa9-474c-b3e3-dd3eb22bd91d
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 18 August 2015
                : 9 October 2015
                : 9 October 2015
                Categories
                Original Article

                arterial ischemic stroke,nephrotic syndrome,atherosclerosis,diabetic nephropathy,hypercoagulability

                Comments

                Comment on this article