School of Convergence Science and Technology, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea.
Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Neurol Sci. 2024 Aug;45(8):3907-3915. doi: 10.1007/s10072-024-07446-3. Epub 2024 Mar 14.
Posterior reversible encephalopathy syndrome (PRES) is characterized by cerebral blood flow dysregulation and the blood-brain barrier (BBB) disruption. While renal insufficiency has been considered a factor in BBB fragility, the relationship between renal insufficiency and the PRES lesions volume remains unclear.
This observational study was performed retrospectively. PRES patients were categorized into two groups with renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m on the day of symptom occurrence. Lesion volume was measured using fluid-attenuated inversion recovery (FLAIR) imaging, and the brain was divided into nine regions. The volume of the parietal-occipital-temporal lobe was considered typical, while the other six regions were labeled as atypical.
The study included 200 patients, of whom 94 (47%) had renal insufficiency. Patients with renal insufficiency had a larger lesion volume (144.7 ± 125.2 cc) compared to those without renal insufficiency (110.5 ± 93.2 cc; p = 0.032); particularly in the atypical lesions volume (49.2 ± 65.0 vs. 29.2 ± 44.3 cc; p = 0.013). However, there was no difference in the reversibility of the lesions (35.2 ± 67.5 vs. 18.8 ± 33.4 cc; p = 0.129). Multiple regression analysis revealed that decreases in eGFR (β = -0.34, 95% CI -0.62-0.05, p = 0.020) were positively associated with total lesion volume.
Our findings suggest that PRES patients with renal insufficiency experience more severe lesion volumes, likely due to the atypical brain regions involvement. The lesions involving atypical regions may have a similar pathophysiology to typical lesions, as the PRES lesions reversibility was found to be similar between individuals with and without renal insufficiency.
后部可逆性脑病综合征（PRES）的特征是脑血流调节紊乱和血脑屏障（BBB）破坏。虽然肾功能不全被认为是 BBB 脆弱性的一个因素，但肾功能不全与 PRES 病变体积之间的关系尚不清楚。
本观察性研究是回顾性进行的。将 PRES 患者分为肾功能不全组和肾功能正常组，定义为症状发生当天估算肾小球滤过率（eGFR）<60 mL/min/1.73m。使用液体衰减反转恢复（FLAIR）成像测量病变体积，将大脑分为 9 个区域。顶枕颞叶的体积被认为是典型的，而其他六个区域被标记为非典型。
本研究纳入了 200 例患者，其中 94 例（47%）有肾功能不全。与肾功能正常组相比，肾功能不全组的病变体积更大（144.7±125.2 cc 比 110.5±93.2 cc；p=0.032）；特别是在非典型病变体积方面（49.2±65.0 比 29.2±44.3 cc；p=0.013）。然而，病变的可逆转性无差异（35.2±67.5 比 18.8±33.4 cc；p=0.129）。多因素回归分析显示，eGFR 降低（β=-0.34，95%CI -0.62-0.05，p=0.020）与总病变体积呈正相关。
我们的研究结果表明，伴有肾功能不全的 PRES 患者病变体积更严重，可能与非典型脑区受累有关。非典型区域的病变可能与典型病变具有相似的病理生理学机制，因为肾功能不全与肾功能正常患者的 PRES 病变可逆转性相似。
