Hemodialysis-related Portal-Systemic Encephalopathy

Abstract

Hemodialysis-related portal-systemic encephalopathy (HRPSE) is characterized by the presence of portosystemic encephalopathy without liver dysfunction, usually caused by changes in the systemic venous flow related to hemodialysis. We herein describe the case of a 75-year-old woman who developed hepatic encephalopathy five years after the initiation of hemodialysis. Abdominal contrast-enhanced computed tomography (CT) and three-dimensional CT angiography revealed a portosystemic venous shunt, and the patient was diagnosed with portosystemic encephalopathy. Occlusion therapy ameliorated her disturbance of consciousness. HRPSE should be recognized as a treatable neuropsychiatric disorder.

門脈体循環シャントによる高アンモニア血症に，非典型溶血性尿毒症症候群による腎不全が影響を及ぼしたと考えられる意識障害患者の1例(A case of hyperammonemic encephalopathy due to a portosystemic shunt affected by renal failure accompanied with atypical hemolytic uremic syndrome)

“…また血液透析とPSSによる高アンモニア血症の関係については様々な報告があり，一貫して血液透析での除水量が多いことが脳症の増悪因子になるとされている 15), 16), 17)。急激な除水で体循環系の静脈圧と門脈圧に圧較差が生まれ，PSSの血流を増やすというのがその理由である。本症例では再入院後にaHUS再燃による腎不全に対して血液透析を施行したが，2日間大きく除水した後しばらくしてアンモニア値の急上昇と意識障害が出現しており（Fig. 3, 4），血液透析による急激な除水が高アンモニア血症に悪影響を及ぼしていた可能性がある。…”

A large-scale investigation by ultrasound of fetal hepatic venous system variants in China

“…To the best of our knowledge, most of the previous studies focused on the fetal HVS shunts [9][10][11][12][13][14], only a few studies reported their variants [15]. The variants of fetal HVS have not been systemically described before.…”