Association of Renal Impairment and Cerebral SVD is Exclusive for Younger Individuals After Adjusting for Vascular Risk Factors: Genetic Predisposition or a Separate Vascular Entity?
Victor J. Del Brutto, MD
Liu B, Lau KK, Li L, Lovelock C, Liu M, Kuker W, et al. Age-Specific Associations of Renal Impairment With Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Transient Ischemic Attack and Stroke. Stroke. 2018
In this article, Bian Lui and colleagues assessed the association of renal impairment with imaging markers of small vessel disease (SVD). As shown in previous studies, small vessel disease usually coexists with renal damage and it has generally been considered that this association is related to simultaneous damage of both the cerebral and the renal microvasculature. The authors presented the results of a population-based study in which they studied age-specific associations of renal impairment and SVD burden adjusting for demographics and traditional vascular risk factors including premorbid blood pressure.
The study was conducted using the Oxford Vascular Study registry from Oxfordshire, United Kingdom. The analysis included 1028 patients with a transient ischemic attack or minor brain infarct that underwent brain MRI and baseline renal function measurement. Patients with systemic vasculitis, CADASIL and Fabry’s disease were excluded. The burden of SVD was determined by the presence of lacunar infarctions, cerebral microbleeds, enlarged basal ganglia perivascular spaces and white matter hyperintensities on brain MRI. Renal impairment was defined by an eGFR <60 mL/min per 1.73 m2. Remarkably, the authors used the premorbid creatinine within a year to avoid the influence of a recent vascular event in the measurement of baseline renal function.