Posterior reversible encephalopathy syndrome-an under recognized manifestation of Chronic Kidney Disease

Vivek B. Kute; Hargovind L. Trivedi; Pankaj R. Shah; Manoj R. Gumber; Himanshu V. Patel; Aruna Vanikar

doi:10.4103/0972-5229.120329

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Posterior reversible encephalopathy syndrome-an under recognized manifestation of Chronic Kidney Disease

Vivek B. Kute, Hargovind L. Trivedi, Pankaj R. Shah, Manoj R. Gumber, Himanshu V. Patel, Aruna Vanikar

Keywords : Chronic kidney disease, hypertension, posterior reversible encephalopathy syndrome

Citation Information : Kute VB, Trivedi HL, Shah PR, Gumber MR, Patel HV, Vanikar A. Posterior reversible encephalopathy syndrome-an under recognized manifestation of Chronic Kidney Disease. Indian J Crit Care Med 2013; 17 (5):318-320.

DOI: 10.4103/0972-5229.120329

License: CC BY-ND 3.0

Published Online: 01-08-2014

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Abstract

First Report of the Indian Chronic Kidney Disease (CKD) Registry showed that patient with CKD in India more frequently presented in Stage V. Many patients have uncontrolled hypertension and uremia due to noncompliance or non affordability of renal replacement therapy which can lead to complications such as posterior reversible encephalopathy syndrome (PRES). A 17-year-old female had end stage renal disease (ESRD) due to malignant hypertension. She developed headaches, altered consciousness, visual disturbances and seizures. A non contrast brain computed tomography revealed bilateral symmetrical white matter hypodensity in parietal, temporal, and occipital region suggesting PRES. Intravenous lorazepam was given for acute control of seizure and she required phenytoin, valproic acid, levetiracetam to control seizures. She was started on more frequent hemodialysis. She required five types of antihypertensive drugs to control blood pressure. We report successful renal transplantation (RTx) in a CKD patient with PRES. Constraints in operating an effective maintenance dialysis program leave RTx as the only viable option for ESRD patients in our country to prevent complications like PRES associated with uremia and uncontrolled hypertension

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