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Posterior reversible encephalopathy syndrome in children with kidney disease

Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiographic entity of heterogeneous etiologies that are grouped together because of similar findings on neuro-imaging and associated symptom complex of headache, vision loss, altered mentation, and seizures. Although usually considered...

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Autores principales: Gera, D. N., Patil, S. B., Iyer, A., Kute, V. B., Gandhi, S., Kumar, D., Trivedi, H. L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927187/
https://www.ncbi.nlm.nih.gov/pubmed/24574628
http://dx.doi.org/10.4103/0971-4065.125053
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author Gera, D. N.
Patil, S. B.
Iyer, A.
Kute, V. B.
Gandhi, S.
Kumar, D.
Trivedi, H. L.
author_facet Gera, D. N.
Patil, S. B.
Iyer, A.
Kute, V. B.
Gandhi, S.
Kumar, D.
Trivedi, H. L.
author_sort Gera, D. N.
collection PubMed
description Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiographic entity of heterogeneous etiologies that are grouped together because of similar findings on neuro-imaging and associated symptom complex of headache, vision loss, altered mentation, and seizures. Although usually considered benign and reversible, characteristics of this syndrome in pediatric patients remain obscure. This case series included 11 patients (8 males, 3 females, age 3-15 years) of PRES during September 2010 to February 2012 out of a total 660 renal pediatric patients (1.66%). We studied their clinical profile, contributory factors, and outcome. Presenting symptoms were headache in 73%, dimness of vision or cortical blindness in 36%, seizures in 91%, and altered mentation in 55%. The associated renal diseases were acute renal failure (55%), chronic renal failure (9%), and 36% had normal renal function. The contributory factors were uncontrolled hypertension (100%), severe hypoproteinemia (9%), persistent hypocalcemia (9%), hemolytic uremic syndrome (36%), cyclosporine toxicity (9%), lupus nephritis (9%), high hematocrit (9%), and pulse methylprednisolone (9%). Brain imaging showed involvement of occipito-parietal area (100%) and other brain areas (63%). All but one patient of hemolytic uremic syndrome had complete clinical neurological recovery in a week, and all had normal neurological imaging after 4-5 weeks. PRES is an underdiagnosed entity in pediatric renal disease patients. Associated hypertension, renal disease, and immunosuppressive treatment are important triggers. Early diagnosis and treatment of comorbid conditions is of prime importance for early reversal of syndrome.
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spelling pubmed-39271872014-02-26 Posterior reversible encephalopathy syndrome in children with kidney disease Gera, D. N. Patil, S. B. Iyer, A. Kute, V. B. Gandhi, S. Kumar, D. Trivedi, H. L. Indian J Nephrol Original Article Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiographic entity of heterogeneous etiologies that are grouped together because of similar findings on neuro-imaging and associated symptom complex of headache, vision loss, altered mentation, and seizures. Although usually considered benign and reversible, characteristics of this syndrome in pediatric patients remain obscure. This case series included 11 patients (8 males, 3 females, age 3-15 years) of PRES during September 2010 to February 2012 out of a total 660 renal pediatric patients (1.66%). We studied their clinical profile, contributory factors, and outcome. Presenting symptoms were headache in 73%, dimness of vision or cortical blindness in 36%, seizures in 91%, and altered mentation in 55%. The associated renal diseases were acute renal failure (55%), chronic renal failure (9%), and 36% had normal renal function. The contributory factors were uncontrolled hypertension (100%), severe hypoproteinemia (9%), persistent hypocalcemia (9%), hemolytic uremic syndrome (36%), cyclosporine toxicity (9%), lupus nephritis (9%), high hematocrit (9%), and pulse methylprednisolone (9%). Brain imaging showed involvement of occipito-parietal area (100%) and other brain areas (63%). All but one patient of hemolytic uremic syndrome had complete clinical neurological recovery in a week, and all had normal neurological imaging after 4-5 weeks. PRES is an underdiagnosed entity in pediatric renal disease patients. Associated hypertension, renal disease, and immunosuppressive treatment are important triggers. Early diagnosis and treatment of comorbid conditions is of prime importance for early reversal of syndrome. Medknow Publications & Media Pvt Ltd 2014 /pmc/articles/PMC3927187/ /pubmed/24574628 http://dx.doi.org/10.4103/0971-4065.125053 Text en Copyright: © Indian Journal of Nephrology http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Gera, D. N.
Patil, S. B.
Iyer, A.
Kute, V. B.
Gandhi, S.
Kumar, D.
Trivedi, H. L.
Posterior reversible encephalopathy syndrome in children with kidney disease
title Posterior reversible encephalopathy syndrome in children with kidney disease
title_full Posterior reversible encephalopathy syndrome in children with kidney disease
title_fullStr Posterior reversible encephalopathy syndrome in children with kidney disease
title_full_unstemmed Posterior reversible encephalopathy syndrome in children with kidney disease
title_short Posterior reversible encephalopathy syndrome in children with kidney disease
title_sort posterior reversible encephalopathy syndrome in children with kidney disease
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927187/
https://www.ncbi.nlm.nih.gov/pubmed/24574628
http://dx.doi.org/10.4103/0971-4065.125053
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