Balloon-occluded retrograde transvenous obliteration was effective for hyperammonemia caused by chronic portal-systemic shunt encephalopathy in hemodialysis patient -A case report

史子, 小島; 美緒, 上田; まどか, 斎藤; 好子, 田中; 優子, 唐鎌; 剛, 輿石; 孝作, 新田; 隆, 秋葉

doi:10.4009/jsdt.45.267

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…In Japan, 12 cases of CPSE in dialysis patients have been reported [1, 2, 3]. The average age of the patients was 62 years, and the sex ratio was 6:6.…”

Section: Discussionmentioning

confidence: 99%

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Chronic Portal-SystemicShunt Encephalopathy in a Hemodialysis Patient Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Yasukawa

Akiyama²,

Tsukishiro³

et al. 2013

Case Rep Nephrol Dial

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We report a case of chronic portal-systemic shunt encephalopathy in a 79-year-old female hemodialysis patient with end-stage renal disease. Approximately 1 month before admission, she occasionally had a discrepant conversation. It was considered that hepatic encephalopathy was caused by an increase in the ammonia level in the blood flow of the shunt, which had been diagnosed 7 years previously between the splenic vein and the left renal vein. On admission, disturbed consciousness and an elevated serum ammonia level (221 μg/dl) were observed. No change in the shunt diameter was noted. Consciousness improved with conservative treatment, whereas hyperammonemia remained. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed on the shunt. As a result, hyperammonemia resolved immediately, and the level of ammonia was maintained at approximately 60 μg/dl. The patient often complained of drug-induced constipation; therefore, an increase in the intra-abdominal pressure in addition to ammonia production in the intestinal tract was suspected as the cause of encephalopathy. More than 23 months have passed since the B-RTO therapy, and no symptoms of encephalopathy have been observed yet.

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“…In Japan, 12 cases of CPSE in dialysis patients have been reported [1, 2, 3]. The average age of the patients was 62 years, and the sex ratio was 6:6.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic encephalopathy is usually observed in patients with liver failure; however, hepatic encephalopathy with no evidence of liver failure has recently been reported in dialysis patients with portal-systemic shunts (PSS) [1, 2, 3]. This condition is called chronic portal-systemic shunt encephalopathy (CPSE).…”

Section: Introductionmentioning

confidence: 99%

Chronic Portal-SystemicShunt Encephalopathy in a Hemodialysis Patient Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Yasukawa

Akiyama²,

Tsukishiro³

et al. 2013

Case Rep Nephrol Dial

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Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Okado

Togo

et al. 2015

Intern. Med.

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The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portalsystemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Therefore, it is necessary to recognize CPSE and assess the blood ammonia concentrations in dialysis patients who develop a disturbance of consciousness, even if the serum transaminase level is normal.

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Balloon-occluded retrograde transvenous obliteration was effective for hyperammonemia caused by chronic portal-systemic shunt encephalopathy in hemodialysis patient -A case report

Cited by 2 publications

References 13 publications

Chronic Portal-SystemicShunt Encephalopathy in a Hemodialysis Patient Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Chronic Portal-SystemicShunt Encephalopathy in a Hemodialysis Patient Treated with Balloon-Occluded Retrograde Transvenous Obliteration

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

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