Limits...
Posterior reversible encephalopathy syndrome in children with kidney disease.

Gera DN, Patil SB, Iyer A, Kute VB, Gandhi S, Kumar D, Trivedi HL - Indian J Nephrol (2014)

Bottom Line: The associated renal diseases were acute renal failure (55%), chronic renal failure (9%), and 36% had normal renal function.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus

Computed tomography/Magnetic resonance imaging images of brain showing positive findings
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3927187&req=5

Figure 2: Computed tomography/Magnetic resonance imaging images of brain showing positive findings

Mentions: Initial cranial imaging revealed fairly symmetrical areas of edema not only involving occipito-parietal white matter regions in majority of cases but also extended to cortical gray matter in nine cases (81%) and extended to fronto-temporal area in five cases (45%), involved basal ganglia also in two patients (case 4 and 11) whereas cerebellum and medulla were also involved in one patient (case 11) [Figure 2].


Posterior reversible encephalopathy syndrome in children with kidney disease.

Gera DN, Patil SB, Iyer A, Kute VB, Gandhi S, Kumar D, Trivedi HL - Indian J Nephrol (2014)

Computed tomography/Magnetic resonance imaging images of brain showing positive findings
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927187&req=5

Figure 2: Computed tomography/Magnetic resonance imaging images of brain showing positive findings
Mentions: Initial cranial imaging revealed fairly symmetrical areas of edema not only involving occipito-parietal white matter regions in majority of cases but also extended to cortical gray matter in nine cases (81%) and extended to fronto-temporal area in five cases (45%), involved basal ganglia also in two patients (case 4 and 11) whereas cerebellum and medulla were also involved in one patient (case 11) [Figure 2].

Bottom Line: The associated renal diseases were acute renal failure (55%), chronic renal failure (9%), and 36% had normal renal function.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India.

ABSTRACT
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.

No MeSH data available.


Related in: MedlinePlus