Abstract
Aims and Objectives: To identify the prevalence of posterior reversible encephalopathy syndrome in patients with renal disease at a single center over a two year duration and to analyse their clinical profile.
Materials and methods: A retrospective analysis of all patients admitted in the ICU under the department of Nephrology in the past 2 years at VPS Lakeshore Hospital and Research Centre, Kochi was done to look for patients with posterior reversible encephalopathy syndrome (PRES). Their presenting symptoms, degree of hypertension, immunosuppression status, recurrence rates, findings on imaging and prognosis after treatment was evaluated.
Results: In 636 intensive care unit (ICU) admissions under Nephrology, there were 6 cases of PRES. 4 were females and 2 were males. The median age was 27.6 years. 4 patients were cases of chronic kidney disease stage V on maintenance hemodialysis, one case was a case of CKD on conservative management and one patient had just undergone living donor kidney transplantation. 1 patient was on calcineurin inhibitors. Three patients (50%) had IgA Nephropathy, one (16.6%) had lupus nephritis, one (16.6%) had membranous nephropathy and one (16.6%) had chronic glomerulonephritis. Clinical features were seizures (50%) and confusion with depressed consciousness (50%). One patient had recurrence of PRES. Three patients (50%) had typical locations of radiological findings whereas three patients (50%) had findings in unusual areas. 5 patients (83.3%) had severe hypertension (BP>180/ 100mm Hg). All patients recovered completely and there was no mortality
Conclusions: posterior reversible encephalopathy syndrome can be seen in association with kidney disease in various scenarios with many atypical features such as atypical radiological distribution and absence of hypertension. It is an under-represented entity and merits further studies.