Posterior Reversible Encephalopathy Syndrome in Kidney Disease

Ganesh, Kartik; Nair, Rajesh; Kurian, George; Mathew, Anil; Sandeep, S; Paul, Zachariah

doi:10.1016/j.ekir.2017.10.017

Cited by 19 publications

(21 citation statements)

References 24 publications

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“…Although the present patient had chronic hypertension, her BP was stable without any abrupt elevations correlated with the onset of RPLS. Of note, although RPLS can be associated with kidney disease in various scenarios, particularly increased BP and calcineurin inhibitor use [ 4 ], this was not observed in the present patient. In fact, pneumonia development was the only variable that immediately preceded the onset of seizures.…”

Section: Discussioncontrasting

confidence: 54%

Infection-provoked reversible posterior leukoencephalopathy syndrome in an adult with nephrotic syndrome: a case report

Chien

Tsai

et al. 2020

BMC Neurol

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Background Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare and heterogeneous clinico-neuroradiological syndrome characterized by headache, altered mental status, seizures, and visual disturbances. Hypertension and immunosuppression are two of the main factors that predispose an individual to RPLS. However, RPLS can develop when no major risk factors are present. RPLS has been reported in pediatric nephrotic patients, but rarely in adults. Case presentation A 42-year-old Asian woman with nephrotic syndrome presented with seizures, headaches, and nausea. Her blood pressure was controlled, and no immunosuppressants had been prescribed. All symptoms and tests indicated RPLS following infection with pneumonia, which was successfully treated by immediate administration antibiotic and anti-epileptic medications. Seizures did not recur during a 2-year follow-up period. Conclusions When patients with nephrotic syndrome have an infection, RPLS symptoms should be investigated thoroughly. With early diagnosis and appropriate treatment of RPLS, morbidity and mortality can be prevented.

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Section: Discussioncontrasting

confidence: 54%

Infection-provoked reversible posterior leukoencephalopathy syndrome in an adult with nephrotic syndrome: a case report

Chien

Tsai

et al. 2020

BMC Neurol

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“…There are few known risk factors for PRES in our patient: renal impairment, 9,10 use of bortezomib, 11‐14 cyclophosphamide, 6‐8 and steroids 15‐17 . In our patient, we believe that the recent use of cyclophosphamide might have contributed to the development of PRES.…”

Section: Discussionmentioning

confidence: 66%

Cyclophosphamide‐induced posterior reversible encephalopathy syndrome: A case report

Shrestha

Nepal

Basnet

et al. 2021

Neurology & Clinical Neurosc

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Posterior reversible encephalopathy syndrome (PRES) is an acute neurological disorder of vascular origin characterized by seizure, headache, encephalopathy, visual disturbances, focal neurological signs, and distinct neuroimaging features such as vasogenic edema, usually on the bilateral parieto-occipital region. 1,2 It occurs in the context of renal failure, autoimmune disorder, cytotoxic drug usage, eclampsia, and preeclampsia. 1 Two theories are most widely accepted to explain pathogenesis. One of the theories is the rapid development of hypertension to the level where autoregulation fails leading to hyperperfusion, vascular leakage, and finally vasogenic edema. Edema is due to the extravasation of plasma proteins and macromolecules through disrupted tight junctions. The other theory suggests PRES is due to endothelial dysfunction due to exogenous (like in immunosuppressive and cytotoxic drugs) and endogenous (like in eclampsia and sepsis) factors. The circulating toxins cause vascular leakage, edema, and release of vasoactive and immunogenic substances. 2,3 Posterior reversible encephalopathy syndrome following administration of cytotoxic agents like calcineurin inhibitors, tyrosine kinase inhibitors, oxaliplatin, bevacizumab, and 5-FU has been

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“…The hypoperfusion theory, on the other hand, proposes that endothelial cell dysfunction, which is seen in sepsis, immunocompromised states, and autoimmune diseases, leads to altered vascular tone and vasoconstriction. The resulting hypoxia leads to the secretion of vascular endothelial growth factor (VEGF) from cerebral vessels, which increases permeability and hence causes edema [ 5 ]. These different theories need not be mutually exclusive, and research is ongoing to better elucidate the exact pathophysiological mechanism involved.…”

Section: Discussionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Tips for Diagnosis and Treatment

Ali

Karan²,

Biswah

et al. 2021

Cureus

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Often described as a clinico-radiological entity, posterior reversible encephalopathy syndrome (PRES) is being increasingly diagnosed nowadays. However, mystery still surrounds its exact etiology. Though there are no standardized diagnostic criteria for this syndrome, there is a consistent feature associated with it: brain vasogenic edema in combination with neurotoxicity. The nonspecific nature of this condition leaves room for the diagnosis to be overlooked, leading to delays in providing appropriate treatment and unfavorable patient outcomes. PRES is associated with a variety of medical conditions including hypertension, eclampsia, autoimmune conditions, renal failure, sepsis, and an immunocompromised state, such as that secondary to the use of immunosuppressive therapy, human immunodeficiency virus (HIV), and organ transplants. Treatment by a multidisciplinary team and prompt identification and reversal of the underlying cause can lead to beneficial outcomes, as in the case we present in this report.

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Posterior Reversible Encephalopathy Syndrome in Kidney Disease

Cited by 19 publications

References 24 publications

Infection-provoked reversible posterior leukoencephalopathy syndrome in an adult with nephrotic syndrome: a case report

Infection-provoked reversible posterior leukoencephalopathy syndrome in an adult with nephrotic syndrome: a case report

Cyclophosphamide‐induced posterior reversible encephalopathy syndrome: A case report

Posterior Reversible Encephalopathy Syndrome: Tips for Diagnosis and Treatment

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