Acute Glomerulonephritis Presenting With PRES: A Report of 4 Cases

Wirrell, Elaine; Hamiwka, Lorie; Grisaru, Silviu; Wei, Xing

doi:10.1017/s0317167100006740

Cited by 22 publications

(15 citation statements)

References 12 publications

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“…However, a direct correlation between hypertensive encephalopathy and renal disease has not been proven. Unlike other etiologies, hypertension originating from renal disease could cause severe hypertension by complex mechanisms, such as renin angiotensin system activation, fluid overload, activated sympathetic tone, and an electrolyte imbalance15,16). This study showed that the renal origin hypertension group had higher mean blood pressure than the nonrenal origin hypertension.…”

Section: Discussionmentioning

confidence: 63%

Clinical characteristics of hypertensive encephalopathy in pediatric patients

et al. 2017

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PurposeThe aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children.MethodsWe retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups.ResultsThe renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05).ConclusionWe conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI.

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Section: Discussionmentioning

confidence: 63%

Clinical characteristics of hypertensive encephalopathy in pediatric patients

et al. 2017

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“…Therefore, it is not uncommon that children with posterior reversible encephalopathy syndrome has been found hypertensive only late in the clinical course, but not in the period of initial presentation. 28 Our observation emphasized the importance of close monitoring of blood pressure in children with critical neurologic illness and that a pediatric neurologist should keep posterior reversible encephalopathy syndrome in high suspicion when hypertension is detected in the context of acute consciousness change or seizures. Neuroradiologic evaluation plays a crucial role for definite diagnosis.…”

Section: Discussionmentioning

confidence: 77%

Posterior Reversible Encephalopathy Syndrome in Children

et al. 2013

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To study presentations and outcome of posterior reversible encephalopathy syndrome in children, we retrospectively analyzed 14 patients admitted to our pediatric intensive care unit. We further assessed 94 additional pediatric cases from a systematic review. Our patients had a mean age of 11.6 years. Their precipitating factors were hypertension (100%), immunosuppressants (71%), antineoplastic agents (21%), and hemodialysis (14%). Initial neurologic manifestations included seizures (100%), mental change (100%), headache (79%), and visual disturbance (57%). After prompt diagnosis by magnetic resonance imaging (MRI) with intensive management, all patients had complete clinical recovery with subsequent radiologic resolution. Systemic literature review indicated that seizures (90%), hypertension (85%), and atypical neuroimaging findings (80%) are common presentations in childhood posterior reversible encephalopathy syndrome. We conclude that in children presenting with seizures and hypertension, a pediatric neurologist should consider posterior reversible encephalopathy syndrome within a comprehensive differential diagnosis of acute encephalopathy. Early recognition and intensive care are essential to ensure complete neurologic recovery in children with posterior reversible encephalopathy syndrome.

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“…Other causal relationships to PRES are more specific to the pediatric population, such as acute lymphocytic leukemia, Ewing sarcoma [35], juvenile lupus [37], acute glomerulonephritis [38 ] and treatment of enuresis with oxybutynin [39 ]. There may be an increased incidence of lesion irreversibility in children undergoing cancer treatment who develop PRES [35].…”

Section: Predisposing Factorsmentioning

confidence: 99%

Posterior reversible encephalopathy syndrome

Pula

Eggenberger

2008

Current Opinion in Ophthalmology

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Acute hypertension, eclampsia, immunosuppressive medication, infection or autoimmune diseases can all result in the clinical syndrome of vasogenic edema in the central nervous system leading to headache, seizure, confusion and frequent visual loss. The biologic basis for the syndrome is likely an insult to cerebral vascular autoregulation. MRI is essential in diagnosing a cerebral cause for visual loss. The ophthalmologist may have the initial opportunity to diagnose the syndrome. Treatment may reverse clinical deficits, and is based on eliminating the etiologic causation.

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Acute Glomerulonephritis Presenting With PRES: A Report of 4 Cases

Cited by 22 publications

References 12 publications

Clinical characteristics of hypertensive encephalopathy in pediatric patients

Clinical characteristics of hypertensive encephalopathy in pediatric patients

Posterior Reversible Encephalopathy Syndrome in Children

Posterior reversible encephalopathy syndrome

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