Clinical Analysis of Kidney Disease Combined with Posterior Reversible Encephalopathy Syndrome in Six Children

Abstract

Objective: Investigating the clinical and imaging characteristics of Posterior Reversible Encephalopathy Syndrome (PRES) with renal disease among children and improving pediatrician awareness of PRES. 

Methods: The clinical presentation, imaging data, treatment, and prognosis of six children diagnosed with kidney disease with PRES at The First Affiliated Hospital of Henan University of Traditional Chinese Medicine between October 2016 and December 2021 were retrospectively analyzed, and relevant literature was reviewed. 

Results: Of six children (five boys and one girl) aged from 7 to 14 years, three had Henoch-Schönlein purpura nephritis (HSPN), two had nephrotic syndrome (NS), and one had lupus nephritis (LN). All children had a history of hormone and immunosuppressant therapy. Clinical manifestations of the six children all had convulsions and consciousness disorder. Five had moderate to severe hypertension, two had dizziness and headaches, two had nausea and vomiting, and one had visual disturbances. Cranial magnetic resonance imaging (MRI) of all six patients was characterized by reversible white matter abnormalities, primarily symmetrical. After controlling convulsions, decreasing cranial pressure, and actively controlling the primary disease, all children made a full recovery to their premorbid state. 

Conclusions: The main clinical manifestations of PRES include convulsions, consciousness disorder, headache, and visual disturbances. Cranial MRI is an important adjunctive test for the diagnosis of PRES. Children with renal disease treated with hormones and immunosuppressants commonly suffer from PRES. With early diagnosis and aggressive treatment, there is a good prognosis for children with PRES.