A transient improvement in renal function occurs after ischemic stroke.

BACKGROUND: Neurohumoral effects have been suggested to affect kidney function. Stroke is a condition where regulation of the renin-angiotensin system and sympathetic nerve activity are altered. METHODS: Renal function as estimated by serum creatinine was analyzed over 1 week in 220 patients after acute ischemic stroke. RESULTS: In patients with chronic kidney disease defined as those with serum creatinine >1.2 mg/dL at admission (n = 62), renal function transiently improved, measured by a mean decrease of creatinine of 0.34 mg/dL during the first days after stroke. A significant and transient decrease of creatinine was also observed in patients with diabetes (n = 69) or patients with heart failure (n = 89). In both subgroups creatinine decreased by a mean of 0.49 and 0.24 mg/dL, respectively (p < 0.05 for both). In patients with normal renal function at admission, no change in serum creatinine occurred during the first week after stroke. There was no association between stroke severity and creatinine change. CONCLUSION: An acute ischemic cerebrovascular event intermittently improves impaired kidney function. The underlying mechanism may involve central regulation of renal function.

Asymmetric dimethylarginine enhances cardiovascular risk prediction in patients with chronic heart failure.

OBJECTIVE: The purpose of this study was to investigate whether elevated asymmetrical dimethylorginine (ADMA) concentrations are associated with increased cardiovascular risk in chronic heart failure (HF) patients. METHODS AND RESULTS: 253 patients with symptomatic chronic HF and impaired left ventricular function (median age 70 years, 202 males) were followed for a median of 14.2 months (interquartile range 6.8 to 21.2). ADMA and N-terminal pro-brain natriuretic peptide (NT-proBNP) were assessed by high performance liquid chromatography and by an enzyme-linked immunosorbent assay, respectively. Subjects with ADMA concentrations in the highest tertile had a significantly higher adjusted hazard ratio (HR; 2.00; 95% confidence interval [CI] 1.01 to 3.97) for occurrence of an end point (cardiac decompensation, major adverse cardiovascular events or all-cause mortality) compared with patients in the lowest tertile (P=0.046) during the first 6 months of follow-up. NT-proBNP also identified subjects at risk before adjustment for confounders at 6 and 12 months of follow-up. HR for patients with ADMA and NT-proBNP in the highest tertile was significantly increased (3.68, CI 1.67 to 8.14; at 6 months follow-up) compared with patients without ADMA and NT-proBNP in the highest tertile (P<0.001). CONCLUSIONS: Elevated ADMA plasma concentrations are associated with adverse cardiovascular outcome in patients with chronic HF. Quantification of ADMA with NT-proBNP improves risk stratification in this cohort.