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Vol. 27. Issue. 5.October 2007
Pages 527-659
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Vol. 27. Issue. 5.October 2007
Pages 527-659
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Posterior reversible encephalopathy syndrome (PRES) and chronic kidney disease
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Sofia Jorge, José António Lopes, Edgar de Almeida, Mateus Martins Prata
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Abstract
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Posterior reversible encephalopathy (PRES) is a recently described syndrome, defined by clinical and neuroimaging features. Chronic kidney disease patients may be especially vulnerable to this syndrome because they are frequently exposed to several of its possible causes, including uremia and hypertension. In its most severe form, PRES can manifest clinically as seizures, coma or death. However, if properly diagnosed and treated, this syndrome can be completely reversible. Therefore, neuroimaging methods, especially brain magnetic ressoance is fundamental for its diagnosis because it shows barin edema in characteristic pattern, and excludes causes of seizures or coma. An important example is the case of a young hypertensive chronic kidney disease patient on peritoneal dialysis, brought to the emergency room comatous with generalized tonic-clonic seizures; the cerebral magnetic resonance imaging features were impressive. Anti-hypertensive therapy and hemodialysis allowed complete recovery. The reversibility of this syndrome depends on timely diagnosis and therapy and therefore it should be kept in mind in the differential diagnosis of seizures. or coma in chronic kidney disease patients.
Keywords:
seizures, chronic kidney disease, peritoneal dialysis, posterior reversible encephalopathy
Posterior reversible encephalopaty (PRES) es una entidad recientemente descrita, definida por aspectos clinicos y neuroimagiologicos. Los doentes renales cronicos son particularmente sensibles a su ocurrencia debido a la frequencia con que presentan numerosas de sus possibles causas, incluso la uremia y la hipertensión. En su forma mas severa, PRES puede presentarse con convulsiones y mismo coma, y si no tratado, puede conducir a consequencias irreversibles o mismo a la muerte. Todabia, la atempada institución de terapeutica pude reverter completamente todo lo quadro; para esó és fundamental la ressonancia magnetica cerebral, que mostra el edema cerebral en localizacion característica. Un exemplo ilustrativo de la importancia del diagnostico y terapeutica atempada es lo caso de un enfermo joven, en diálisis peritoneal, llevado al departamento de emergencia medica en coma, despues de presentar convulsiones tonico-clonicas generalizadas; la ressonacia magnetica cerebral era impresionante. Con hemodiálisis y medicacion anti-hipertensora, la recuperacion ha sido completa. La reversibilidad de lo síndrome depende del correcto y atempado diagnostico y terapeutica, por lo que este síndrome deberá ser considerado en lo diagnostico diferencial de convulsiones y coma en lo doente renal cronico.
Palabras clave:
convulsiones, doença renal cronica, dialisis peritoneal, encefalopatia posterior reversible
Idiomas
Nefrología (English Edition)
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