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The association between cerebrovascular disease and decreased kidney function have been established with albuminuria itself being a risk factor for stroke, independent of estimated glomerular filtration rate (eGFR).  This quality assurance project aims to detect the presence and severity of albuminuria in patients with acute hemorrhagic and ischemic strokes and to evaluate the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), with the intention of addressing this as a major risk factor involved in the pathogenesis of stroke.

In this prospective cohort study, 148 patients admitted to our institution with a diagnosis of acute ischemic stroke (119) or intracranial hemorrhage (29) were screened for albuminuria with spot urine nephrology panel.  Based on the albumin to creatinine ratio, patients were divided into four groups: no microalbuminuria (<30mg/day), microalbuminuria (30-300 mg/day), overt sub-nephrotic albuminuria (300mg-3g/day), nephrotic range albuminuria (>3g/day).  Patients with >30 mg/day albuminuria not taking ACE/ARB were subsequently started on ACE/ARB as appropriate.  The severity of albuminuria was cross tabulated with use of ACE/ARB on admission, at discharge, and stroke subtype.

Of the 148 patients admitted with either acute ischemic stroke or intracranial hemorrhage, 45 (30.4%) were on ACE/ARB prior to admission. On discharge, 110 patients (74.3%) were on an ACE/ ARB for treatment of albuminuria. There was no significant difference in ACE/ARB use among those classified by albuminuria severity on admission (p=0.208). However, on discharge there was a strong association with patients who had albuminuria severity of greater than 30mg/day with ACE/ARB use at discharge (p<0.0001).

In this prospective cohort study at a single stroke center, patients admitted with acute hemorrhagic or ischemic stroke who underwent screening for albuminuria with urine nephrology panel had an increase of ACE/ARB use by over twofold. This suggests the importance of albuminuria screening for secondary stroke prevention.