Posterior reversible encephalopathy syndrome in children with kidney disease

Area of Science:

• Neurology
• Pediatrics
• Nephrology

Background:

• Posterior reversible encephalopathy syndrome (PRES) is a complex neurological condition with varied causes.
• Its presentation and characteristics in pediatric patients, especially those with renal disease, are not well understood.
• PRES typically involves headache, vision loss, altered mentation, and seizures, with characteristic neuro-imaging findings.

Purpose of the Study:

• To investigate the clinical profile, contributing factors, and outcomes of PRES in pediatric patients with renal disease.
• To highlight PRES as a potentially underdiagnosed entity in this population.
• To identify key triggers and emphasize the importance of early diagnosis and management.

Main Methods:

• A case series of 11 pediatric patients diagnosed with PRES between September 2010 and February 2012.
• Patients were selected from a total of 660 pediatric renal disease patients, representing a 1.66% incidence.
• Data collected included clinical symptoms, associated renal diseases, identified contributory factors, neuro-imaging results, and patient outcomes.

Main Results:

• PRES occurred in 1.66% of pediatric renal patients, with common symptoms including headache (73%), seizures (91%), and altered mentation (55%).
• Associated conditions included acute renal failure (55%), hemolytic uremic syndrome (36%), and uncontrolled hypertension (100%).
• Neurological recovery was rapid (within a week for most) with normalized imaging, underscoring the syndrome's reversibility when managed promptly.

Conclusions:

• PRES is an underdiagnosed condition in children with renal diseases.
• Uncontrolled hypertension, renal disease, and immunosuppressive therapies are significant triggers for PRES in this cohort.
• Prompt diagnosis and management of associated conditions are vital for achieving complete and early reversal of PRES symptoms and imaging abnormalities.