Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece.
Nephron Clin Pract. 2013;123(3-4):180-4. doi: 10.1159/000353731. Epub 2013 Aug 6.
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiologic entity characterized by headache, visual disturbances, seizures, and the presence of edema on MRI scan, predominantly in the posterior white matter. Regarding end-stage renal disease (ESRD) and PRES, only a few cases of children on peritoneal dialysis (PD) and adults on hemodialysis have been described in the literature.
We report 4 cases of adult patients on PD who presented with PRES, all of which were due to hypertension and inadequate management of fluid balance. The patients expressed typical PRES symptoms such as headache, visual disorders, and tonic/clonic seizures. The patients recovered completely and the MRI lesions disappeared after strict control of volume status.
Nephrologists should be aware of the syndrome, especially when they manage hypertensive ESRD patients not compliant with the fluid and diet restrictions. MRI scan is the only diagnostic tool for defining the syndrome. Early diagnosis is important, since complete remission is achieved after appropriate treatment.
后部可逆性脑病综合征（PRES）是一种临床影像学实体，其特征为头痛、视力障碍、癫痫发作和 MRI 扫描上的水肿，主要位于后白质。关于终末期肾病（ESRD）和 PRES，文献中仅描述了少数腹膜透析（PD）的儿童和血液透析的成人病例。
我们报告了 4 例 PD 成年患者出现 PRES，均因高血压和液体平衡管理不当所致。患者表现出典型的 PRES 症状，如头痛、视力障碍和强直/阵挛性癫痫发作。患者在严格控制容量状态后完全恢复，MRI 病变消失。
肾病学家应意识到这种综合征，尤其是在管理不遵守液体和饮食限制的高血压 ESRD 患者时。MRI 扫描是定义该综合征的唯一诊断工具。早期诊断很重要，因为适当治疗后可完全缓解。
