Portosystemic Encephalopathy in a Patient Treated With Peritoneal Dialysis

Paraíso, Vicente; Francos, Marcelo; Rodríguez-Berzosa, Fernando; Felipe, C.; López‐Valdés, Eva; Martín, Rocío Moulín; Blázquez, Javier; Chacón, C. Rubio; Fidalgo, A.; Martín, Javier

doi:10.1053/j.ajkd.2007.03.001

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…It is difficult to diagnose CPSE because the serum transaminase level is normal, with the exception of hyperammonemia. Recently, CPSE has been recognized to be a cause of disturbance of consciousness in patients receiving dialysis (3)(4)(5)(6). Dialysis patients may develop CPSE for several reasons, including the growth of PSS due to fluid overload and an increase in back flow via the PSS as a result of hemodialysis-related fluid removal (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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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Section: Introductionmentioning

confidence: 99%

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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“…Ubara et al [2] suggested that removing excess fluid slowly via peritoneal dialysis was superior to hemodialysis in the treatment of CPSE because relatively rapid reduction in venous pressure in hemodialysis may cause an increase in the PSS flow. In contrast, Paraíso et al [13] reported that increased IAP because of peritoneal dialysis causes an increase in the PSS flow, and recovery from CPSE was achieved via hemodialysis. In our case, we speculate that increased PSS flow was caused by an increase in IAP rather than by a reduction of venous pressure because an immediate recovery of consciousness was observed after hemodialysis.…”

Section: Discussionmentioning

confidence: 98%

“…On laparoscopic examinations, IAP was observed to increase to approximately 15 mm Hg [12]. (2) Peritoneal dialysis possibly contributes to the development of CPSE with elevation of IAP [13]. Thus, repeated elevation of IAP with strain pressure seemed to increase the congenital shunt size and to cause a relative decrease in portal flow and a concomitant increase in the PSS flow.…”

Section: Discussionmentioning

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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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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“…Peritoneal dialysis does not typically induce these changes as it involves the very gradual removal of body fluids. Nevertheless, one case of a French patient who devel- oped portosystemic encephalopathy after peritoneal dialysis was reported (17). Hence, the presence of congenital abdominal shunt vessels and removal of a large fluid volume during hemodialysis may result in HRPSE.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis-related Portal-Systemic Encephalopathy

et al. 2015

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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.

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Portosystemic Encephalopathy in a Patient Treated With Peritoneal Dialysis

Cited by 10 publications

References 11 publications

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

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

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

Hemodialysis-related Portal-Systemic Encephalopathy

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