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Acute hypertensive encephalopathy in minimal change nephrotic syndrome
F K Assadi1, L L Lansky, E G John
1Department of Pediatrics, University of Illinois College of Medicine, Chicago.
Insights
A child with minimal change nephrotic syndrome experienced acute hypertensive encephalopathy, leading to coma and cortical blindness. This rare presentation highlights a severe neurological complication of childhood nephrotic syndrome.
Area of Science:
- Pediatric Nephrology
- Neurology
- Critical Care Medicine
Background:
- Minimal change nephrotic syndrome (MCNS) is a common cause of nephrotic syndrome in children.
- Acute hypertensive encephalopathy is a rare but serious complication.
Observation:
- A 3-year-old child with MCNS presented with severe symptoms including coma, seizures, hemiparesis, aphasia, and cortical blindness.
- Symptoms persisted for 24 hours despite aggressive antihypertensive and anticonvulsant treatment.
Findings:
- Visual-evoked potential studies confirmed cortical blindness.
- CT scans revealed symmetric occipital white matter lucencies, suggesting ischemia or edema.
- This presentation is unusual, as it occurred in MCNS without other glomerulonephritis types.
Implications:
- This case expands the understanding of hypertensive encephalopathy complications in childhood nephrotic syndrome.
- It underscores the importance of vigilant neurological monitoring in pediatric patients with MCNS.
- The findings may inform differential diagnoses for similar neurological presentations in children.
Abstract:
A 3-year-old child with minimal change nephrotic syndrome (MCNS) developed an acute hypertensive encephalopathy characterized by coma, focal seizures, right hemiparesis, global aphasia and cortical blindness. Episodic hypertension and seizures persisted for 24 h despite intervention with antihypertensive and anticonvulsant therapy. Clinical suspicion of cortical blindness was confirmed by visual-evoked potential studies. CT scans performed 14 and 21 days after the acute episode demonstrated symmetric occipital white matter lucencies compatible with ischemia and/or associated edema. Hypertensive encephalopathy with cortical blindness and symmetric white matter hypodense lesions visualized on CT scan have recently also been described in eclampsia of pregnancy. This report documents an unusual acute hypertensive encephalopathy in childhood MCNS, unassociated with membranoproliferative glomerulonephritis, or progressive focal glomerulosclerosis.