A Study on Microalbuminuria in Non Diabetic Recent Ischemic Stroke Patients

INTRODUCTION: Cerebrovascular diseases include one of most common and devastating disorders worldwide. These include ischemic stroke, haemorrhagic stroke, AV malformations, and intracranial aneurysms. This causes one of the major causes of disability. There are major risk factors for the stroke which can be prevented by awareness and prevention programs and warning signals by the public and stress on the preventive training in medical education will reduce the stroke prevention gap. There is a growing interest in the pathogenesis of ischemic stroke because nearly fifty percent of cerebrovascular disease risk factors identified were traditional risk factors. Hence leads to search for new risk factors and treatment. The markers of inflammation like C- reactive protein, intracellular adhesion molecule-1, lipoprotein associated phospholipase A2, increased white blood cell count, endothelial nitric oxide synthase, infectious etiologies like Chlamydiae pneumonia, Helicobacter pylori and cytomegalovirus, Homocysteine, Tissue factor Fibrinogen, Lipoprotein (a), Small dense LDL, cytokine transforming growth factor, etc, have been identified as new risk factors for stroke. Another upcoming risk factor for the growing list is said to be microalbuminuria. Microalbuminuria has been associated with disease like diabetic nephropathy, hypertension with left ventricular hypertrophy and renal insufficiency etc. Microalbuminuria has been associated with risk factors for stroke like diabetes, hypertension aging, history of myocardial infarction, obesity, smoking. But there was meager knowledge in connection as independent risk factor for stroke or as a predictor of stroke outcome. So there were many studies in the world to demonstrate the microalbuminuria as a risk factor for stroke and predictor of stroke outcome in non diabetic individuals. AIMS AND OBJECTIVES: 1. To determine the presence of microalbuminuria in the recent ischemic cerebrovascular disease who are non – diabetic individuals. 2. To study the prognostic significance of microalbuminuria in recent ischemic cerebrovascular individuals. METHODOLOGY: Source of data: The patients admitted both in the department of medicine and department of Neurology in Government Rajaji Hospital affiliated to Madurai medical college between January 2012 to May 2012 were taken in our study. Ethical committee approval was obtained Collection of datas: 1. Prospective observational study 2. There were 50 patients enrolled in the study diagnosed and clinically confirmed by CT Scan brain Inclusion criteria: 1. Patients were diagnosed as stroke according to WHO criteria which includes patients of any age and both sexes within 48 hours onset of symptoms. 2. Ischemic infarct confirmed by CT scan. 3. Informed consent obtained from the patient. Exclusion criteria: 1. Patients with haemorrhagic stroke 2. Patients with diabetes who is on antidiabetics or Fasting blood glucose > 126mg/dl or Random blood glucose > 200 mg /dl. 3. Any abnormal urinalysis. 4. Patients who are on antihypertensives or with cut off value for blood pressure > 140mm hg in systolic and >90 mm hg in diastolic. SUMMARY : 1. The subjects were taken consists of 50 acute ischemic stroke patients of age 55.80 years as cases with 32 males and 10 females. 2. The controls were age and sex matched of 50 old stroke patients. 3. The cases and controls were matched with presenting factors. 4. Among the case the 26(52%) were right sided hemiparaesis and 20(40%) were left sided hemiparesis. 5. Among the CT scan results predominant lesions were middle cerebral artery. 6. Patients with microalbuminuria has higher incidence with presenting factors such as aphasia, loss of consciousness. H/o peripheral vascular events were higher in patients with micro albuminuria which is statistically significant H/o smoking also found to be higher in patients with micro albuminuria which is statistically significant. 7. In our study with recent ischemic stroke 20 patients (40%) had Micro albuminuria and among the controls only 7 patients had microalbuminuria. Hence patients with recent ischemic stroke were 2.58 times were higher incidence of microalbuminuria than without microalbuminuria and was found statistically significant with p= 0.447. 8. There are 17/20 subjects with microalbuminuria (85%) had loss of consciousness whereas 8/30 subjects without microalbuminuria had loss of consciousness. Therefore microalbuminuria were found to be associated with severity of the stroke. 9. The Total cholesterol were 194.1±15.06 LDL were 110.1±9.01, HDL were 45.3±4.76 and triglyceride s 196.5±5.42 were found in subjects with microalbuminuria whereas total cholesterol were 196.6±12.23, LDL 105.5±7.40, HDL 45.3±4.76, triglycerides 198.7±10.28. This difference were not statistically significant. 10. The NIHSS scores were found to have high in subjects with microalbuminuria as compared to subjects without micro albuminuria. Hence microalbuminuria had significant correlation with the severity of the stroke. 11. Functional assessment grading were done using modified rankins scale found to have higher scores in subjects with microalbuminuria than without microalbuminuria CONCLUSION: There are many studies that have documented microalbuminuria as a risk factor for acute ischemic stroke. Our study demonstrated microalbuminuria in (40%) of non diabetic acute ischemic stroke and is consistent with previous study associating microalbuminuria in atherosclerotic vascular disease. In our study measuring the presence of microalbuminuria was found to be a strong predictor of stroke outcome after 6 weeks of stroke. The poor neurological deficit during the course of the disease correlates with microalbuminuria. This study gives the indirect prediction of microalbuminuria as a independent risk factor for stroke outcome