Posterior reversible encephalopathy syndrome in children with kidney diseases

Area of Science:

• Neurology
• Nephrology
• Radiology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible leukoencephalopathy, often associated with renal insufficiency, hypertension, or immunosuppressive therapy.
• PRES is notably prevalent in pediatric patients with kidney diseases, highlighting the importance of awareness among pediatric nephrologists.

Purpose of the Study:

• To provide a comprehensive overview of Posterior Reversible Encephalopathy Syndrome (PRES) relevant to pediatric nephrology.
• To emphasize diagnostic approaches, predisposing factors, clinical manifestations, and imaging modalities for PRES.

Main Methods:

• Review of existing literature on PRES, focusing on its association with renal diseases and immunosuppressive therapies.
• Analysis of diagnostic criteria, including clinical symptoms and imaging findings, particularly cranial magnetic resonance (MR) imaging.

Main Results:

• Hypertension and calcineurin inhibitors are identified as major predisposing factors for PRES.
• Nephrotic syndrome is a common underlying condition; frequent symptoms include altered consciousness, seizures, headache, and visual disturbances.
• Cranial MR imaging is the primary diagnostic tool, with diffusion-weighted imaging and ADC mapping showing future potential for improved specificity.

Conclusions:

• PRES diagnosis requires a comprehensive evaluation of predisposing factors, clinical presentation, and imaging.
• Prompt management of PRES typically leads to symptom resolution within weeks.
• Further research into PRES pathophysiology and advanced imaging techniques is warranted for enhanced diagnostic accuracy.