Posterior reversible encephalopathy syndrome: A conundrum of nephrotic syndrome complication
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Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
Department of Radiology, Hospital Raja Permaisuri Bainun, Ipoh, Perak, MALAYSIA
Online publication date: 2023-01-14
Publication date: 2023-03-01
Electron J Gen Med 2023;20(2):em453
Nephrotic syndrome is a kidney disease with proteinuria, hypoalbuminemia, and edema. One rare, potentially life-threatening complication of nephrotic syndrome is posterior reversible encephalopathy syndrome (PRES). Sudden episodes of neurological symptoms such as headache, confusion, seizures, or focal neurological deficits with radiological findings of white matter abnormalities in the parietal and occipital lobes characterize it. Multiple factors predispose an individual with nephrotic syndrome to PRES, such as uncontrolled hypertension, reduced serum albumin levels, administration of drugs (cyclosporine, tacrolimus), anasarca, disturbed body fluid status and renal insufficiency. Here, we report a case of PRES in a seven-year-old girl with nephrotic syndrome who presented with high blood pressure while admitted to the ward. Her neurological symptom rapidly recovered after the control of hypertension. Recurrence of acute severe hypertension, nephrotic state (edema/ hypoalbuminemia), and renal insufficiency may lead to recurrent PRES. Thus, early treatment of trigger factors, especially of hypertension, is vital to reduce the episodes of PRES.
Noone DG, Iijima K, Parekh R. Idiopathic nephrotic syndrome in children. Lancet. 2018;392(10141):61-74. PMid:29910038.
Warejko JK, Tan W, Daga A, Schapiro D, et al. Whole exome sequencing of patients with steroid-resistant nephrotic syndrome. Clin J Am Soc Nephrol. 2018;13(1):53-62. PMid:29127259 PMCid:PMC575330.
McGrogan A, Franssen CF, de Vries CS. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrol Dial Transplant. 2011;26(2):414-30. PMid:21068142.
Park SJ, Shin JI. Complications of nephrotic syndrome. Korean J Pediatr. 2011;54(8):322-8. PMid:22087198 PMCid:PMC3212701.
Ishikura K, Ikeda M, Hamasaki Y, Hataya H, et al. Nephrotic state as a risk factor for developing posterior reversible encephalopathy syndrome in paediatric patients with nephrotic syndrome. Nephrol Dial Transplant. 2008;23(8): 2531-6. PMid:18258739.
Hinchey J, Chaves C, Appignani B, Breen J, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med. 1996;334(8):494-500. PMid:8559202.
Wright RR, Mathews KD. Hypertensive encephalopathy in childhood. J Child Neurol. 1996;11(3):193-6. PMid:8734020.
Gera DN, Patil SB, Iyer A, Kute VB, et al. Posterior reversible encephalopathy syndrome in children with kidney disease. Indian J Nephrol. 2014;24(1):28-34. PMid:24574628 PMCid:PMC3927187.
Chen T-H. Childhood posterior reversible encephalopathy syndrome: Clinicoradiological characteristics, managements, and outcome. 2020. 8. PMid:33042923 PMCid:PMC7518237.
Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet. 2000;356(9227):411-7. PMid:10972386.
Cordelli DM, Masetti R, Ricci E, Tony F, et al. Life-threatening complications of posterior reversible encephalopathy syndrome in children. Eur J Paediatr Neurol. 2014;18(5):632-40. PMid:24814477.
Hobson EV, Craven I, Blank SC. Posterior reversible encephalopathy syndrome: A truly treatable neurologic illness. Perit Dial Int. 2012;32(6):590-4. PMid:23212858 PMCid:PMC3524908.