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Published on: October 17, 2018
Renal dysfunction is associated with deep cerebral microbleeds but not white matter hyperintensities in patients with
Mona Laible1, Solveig Horstmann2, Markus Möhlenbruch3
1Department of Neurology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany. mona.laible@med.uni-heidelberg.de.
Abstract:
Kidney disease is a risk factor for cerebral microangiopathy and spontaneous intracerebral hemorrhage (ICH). We aimed to determine the association of renal dysfunction (RD) with MRI correlates of different patterns of cerebral microangiopathies including cerebral microbleeds (CMB) and white matter lesions (WML) in patients with ICH. In a prospectively collected, single-center cohort of ICH patients, glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease equation. We classified the renal function in five categories: category 1 (eGFR ≥ 90 mL/min/1.73 m(2)), category 2 (eGFR 60-89), category 3 (eGFR 30-59), category 4 (eGFR 15-29), and category 5 (eGFR <15) and dichotomized at an eGFR of 60. Number, location, and extent of CMB and WML were measured on MRI. ICH and CMB locations were classified as lobar or deep. 97 ICH patients with MRI (mean age 65.9 ± 13.9 years) were included. Intracerebral hemorrhage was lobar in 52.6 %. Median eGFR was 85.8 mL/min/1.73 m(2) (IQR 34.3). Renal dysfunction was present in 12.4 % of the patients. At least one CMB was present in 57.7 % of patients, WML were even more frequent (97.7 %). Age and impaired renal function were factors independently associated with the presence of CMB. The presence of CMB was independently associated with the number and extent of WML. RD is a frequent comorbidity in patients with ICH. Associations of RD with hypertension and with CMB in deep location suggest a predominant impact of RD on deep rather than on lobar microangiopathy.
Insights
Kidney dysfunction is common in stroke patients and linked to brain microbleeds. Impaired kidney function is associated with more white matter lesions, particularly in deep brain areas.
Area of Science:
- Neurology
- Nephrology
- Radiology
Background:
- Kidney disease is a known risk factor for cerebral microangiopathy and intracerebral hemorrhage (ICH).
- Cerebral microangiopathies, including cerebral microbleeds (CMB) and white matter lesions (WML), are common findings in patients with ICH.
Purpose of the Study:
- To investigate the association between renal dysfunction (RD) and MRI-defined cerebral microangiopathies in patients with ICH.
- To determine if RD impacts the presence, number, and location of CMB and WML.
Main Methods:
- Prospective, single-center cohort study of 97 ICH patients with MRI.
- Renal function assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation.
- CMB and WML presence, number, extent, and location (lobar vs. deep) quantified on MRI.
Main Results:
- 12.4% of ICH patients had renal dysfunction (eGFR < 60 mL/min/1.73 m²).
- Age and RD were independently associated with the presence of CMB.
- CMB presence was independently associated with a higher number and extent of WML.
- RD was associated with deep CMB, suggesting a greater impact on deep microangiopathy.
Conclusions:
- Renal dysfunction is a frequent comorbidity in ICH patients.
- RD is associated with specific patterns of cerebral microangiopathy, particularly deep CMB and WML.
- These findings highlight the interconnectedness of kidney and brain health in the context of cerebrovascular disease.
