Factors Associated with Neonatal Arterial Hypertension: Case and Control Study

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Carolina Gutiérrez-Cortés

Carolina Gutiérrez-Cortés1, Catalina Lince-Rivera2, Adriana P. Bohórquez-Peñaranda3, Mariangel Castillo-Arteaga4, Ingrid Mayerly Gómez5, Juan Guillermo Cárdenas-Aguilera 6

1 Specialist in pediatric, Pontificia Universidad Javeriana, Bogotá, Colombia
2 Specialist in pediatric and neonatology, Pontificia Universidad Javeriana, Bogotá, Colombia
3 MSc Clinical Epidemiology, Pontificia Universidad Javeriana, Bogotá, Colombia
4 Specialist in pediatric nephrology, Hospital Universitario San Ignacio, Bogotá, Colombia
5 Specialist in pediatric and neonatology, Pontificia Universidad Javeriana, Bogotá, Colombia
6 Specialist in pediatric nephrology, Subred Integrada de Servicios de Salud Sur Occidente, Bogotá, Colombia

Corresponding author:
Juan Guillermo Cárdenas Aguilera
Pontificia Universidad Javeriana
Bogotá, Colombia
Tel (+57) 601 320 8320
Cra 7 No 40 - 62
Email: cardenasjg@javeriana.edu.co

 

Abstract

Background. Neonatal high blood pressure has been diagnosed more frequently in recent years, and its impact extends to adulthood. However, the knowledge gaps on associated factors, diagnosis, and treatment are challenging for medical personnel. The incidence of this condition varies depending on neonatal conditions. Patients in the Newborn Unit are at increased risk of developing high blood pressure. The persistence of this condition beyond the neonatal stage increases the risk of cardiovascular disease and chronic kidney disease in childhood and adulthood.
Methodology. A case-control study was carried out. It included hospitalized patients with neonatal hypertension as cases. Three controls were randomly selected for each case and matched by gestational age. The variables were analyzed based on their nature. Multivariate analysis was performed using a multivariate conditional regression model to identify variables associated with the outcome. Finally, the model was adjusted for possible confounders.
Results. 37 cases were obtained and matched with 111 controls. In the univariate analysis, heart disease (OR 2.86; 95% CI 1.22-6.71), kidney disease (OR 7.24; 95% CI 1.92-28.28), bronchopulmonary dysplasia (OR 6.62; 95% CI 1.42-50.82) and major surgical procedures (OR 3.71; 95% CI 1.64-8.39) had an association with neonatal arterial hypertension. Only the latter maintained this finding in the multivariate analysis (adjusted OR 2.88; 95% CI 1.14-7.30). A significant association of two or more comorbidities with neonatal arterial hypertension was also found (OR 3.81; 95% CI 1.53-9.49).
Conclusions. The study analyzed the factors related to high blood pressure in hospitalized neonates, finding relevant associations in the said population. The importance of meticulous neonatal care and monitoring of risk factors such as birth weight and major surgeries is highlighted.

Keywords: Hypertension, Prematurity, Bronchopulmonary Dysplasia, Epigenetics, Neonate, Prematurity, Kidney Disease, Blood Pressure

Introduction

With technological advances in neonatal care, Newborn Units (NU) have undergone significant changes, increasing survival in low-weight patients due to prematurity or intrauterine growth retardation. Low birth weight (LBW) is determined to correspond to weights less than 2500 grams (Table 1).

Birth Weight
Less than 2500 g Low birth weight
Less than 1500 g Very low birth weight
Less than 1000 g Extremely low birth weight
Table 1. Low birth weight classifications. Adapted and translated from Atehortua et al. [1].

 

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Anti-angiogenic drugs and hypertension: from multidisciplinary collaboration to greater care

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Giulia Sabetta

Francesca Tunesi1, Marco Simonini1, Giulia Sabetta2, Alice Bergamini2, Raffaella Cioffi2, Emanuela Raiabiotti2, Paolo Manunta1, Giuseppe Vezzoli1, Giorgia Mangili3, Chiara Livia Lanzani1

1 U.O. Nefrologia e Dialisi, IRCCS Ospedale San Raffaele, Milano, Italia; Università Vita Salute San Raffaele, Milano, Italia
2 U.O. Ginecologia ed Ostetricia, IRCCS Ospedale San Raffaele, Milano, Italia; Università Vita Salute San Raffaele, Milano, Italia
3 U.O. Ginecologia ed Ostetricia, IRCCS Ospedale San Raffaele, Milano, Italia

Corresponding author:
Giulia Sabetta
U.O. Ginecologia ed Ostetricia, IRCCS Ospedale San Raffaele, Università Vita Salute San Raffaele
Via Olgettina 60
20132, Milano, Italia.
Tel +39 02 2643 5595
E-mail: sabetta.giulia@hsr.it

 

Abstract

Anti-angiogenic drugs are widely used in cancer therapy. Their main targets of action are the vascular endothelial growth factor (VEGF) and its receptors (VEGF-R). Anti-angiogenic drugs are used to reduce the growth of the tumor and its metastases by acting on the phenomenon of tumor neo-angiogenesis. However, they are known for their side effects such as hypertension, acute kidney injury (AKI), and congestive heart failure.
Methods: retrospective study conducted on 57 consecutive patients known for ovarian cancer. Patients treated with Bevacizumab, as first-line, relapse, or maintenance treatment (2015-2022).
Results: according to FIGO staging, 98.2% (56 out of 57) of the patients in the study had third degree disease (G3). 49% of patients developed hypertension after starting Bevacizumab therapy (82% grade 2 according to CTCAE v.5). 89% of hypertensive patients started treatment and its management was multidisciplinary with nephrological consultation in 68% of cases. Only 3 out of 57 women discontinued treatment due to hypertension, and in only one of them it was not possible to restart it.
Conclusions: the evaluation of the patient by a multidisciplinary team (gynecologist and nephrologist) is essential to minimize the morbidity and mortality of patients, and to avoid the interruption of antineoplastic treatment.

Keywords: anti-angiogenic drugs, kidney injury, proteinuria, hypertension, ovarian cancer, multidisciplinary team

Sorry, this entry is only available in Italian.

Introduzione

I farmaci anti-angiogenici hanno lo scopo di prevenire e/o rallentare la crescita tumorale. Questi possono causare diversi effetti collaterali, tra i quali emerge l’ipertensione, definita nella Common Terminology Criteria for Adverse Events (CTCAE) come pressione arteriosa (PA) >140/90 mmHg o un aumento della pressione arteriosa diastolica (PAD) >20 mmHg rispetto al basale.

In questo lavoro, che vuole essere un percorso in questo complesso ambito onconefrologico, presentiamo dapprima il caso di una donna di 74 anni affetta da tumore dell’ovaio trattata con Bevacizumab che, a causa dello sviluppo di ipertensione, ha dovuto interrompere il trattamento, ripreso poi grazie alla valutazione della paziente da parte di un’equipe multidisciplinare (ginecologo e nefrologo). Vengono quindi riportati i risultati di uno studio retrospettivo su 57 pazienti consecutive trattate con Bevacizumab con lo scopo di verificare se e come la collaborazione interdisciplinare tra nefrologo e ginecologo fosse efficacie e funzionale: è stata valutata l’incidenza di ipertensione e proteinuria, se fosse stato richiesto consulto specialistico nefrologico e se fosse stato completato il trattamento. 

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Controversy in estimating glomerular filtration rate through traditional equations in transgender people: discussion through a case report

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Ingrid Sarmento Guedes

Ingrid Sarmento Guedes1, Luiz Valério Costa Vasconcelos1, Ana Paula Pires Lázaro de Oliveira1, Elizabeth De Francesco Daher2, Geraldo Bezerra da Silva Junior1,2

1 Corso di Medicina, Centro di Scienze della Salute, Universidade de Fortaleza. Fortaleza, Ceará, Brasile.
2 Dipartimento di Medicina Clinica, Facoltà di Medicina, Universidade Federal do Ceará. Fortaleza, Ceará, Brasile.

Corresponding author:
Prof. Geraldo Bezerra da Silva Junior.
Universidade de Fortaleza. Av. Washington Soares, 1321, Bloco E, Sala E-01. CEP: 60811-905.
Fortaleza, Ceará, Brasile.
E-mail: geraldobezerrajr@unifor.br

 

Abstract

Introduction: Chronic kidney disease (CKD) and the number of transgender people is on the rise. Hormone replacement therapy may be associated with the development of adverse effects, including kidney disease.
Objective: To report the case of a transgender patient using hormone therapy who developed CKD.
Case Report: Male transgender patient, 28 years old, using testosterone cypionate every 15 days, without any comorbidity. Evolved with hypertensive peaks of 160-150/110 mmHg and loss of kidney function (Ur 102 mg/dl, Cr 3.5 mg/dl, estimated Glomerular Filtration Rate (eGFR) of 22 ml/min/1.73m2 considering male gender and 16.6 ml/min/1.73m2 considering female gender). Abdominal ultrasound showed chronic parenchymal nephropathy. Due to the significant reduction in eGFR, the patient was referred for kidney transplantation, but he was not included in the list because he had a creatinine clearance of 23 ml/min/1.73m2 for males and 21.5 ml/min/1.73m2 for females in the most recent tests.
Conclusion: Hormone replacement may have contributed to the increase in the patient’s blood pressure and, consequently, to the development of CKD. There is still no well-established consensus on the best way to estimate the GFR in transgender people, and it seems to be more appropriate to consider the gender to which the person self-identifies or to perform the calculation for both genders, obtaining an estimate of the range in which the patient’s GFR lies.

Keywords: Transgender persons, chronic renal insufficiency, hypertension, hormone replacement therapy.

Sorry, this entry is only available in Italian.

Introduzione

La malattia renale cronica (MRC) è un grave problema di salute pubblica in tutto il mondo, che colpisce tra il 9,1% e il 15% degli adulti [1, 2]. In Brasile, l’insufficienza renale cronica ha mostrato un numero crescente negli ultimi decenni, con oltre 144 000 pazienti attualmente in dialisi [3]. Parallelamente, c’è un numero crescente di persone transgender, con una stima di oltre 1 milione negli Stati Uniti e 150 000 in Canada [4–6]. In un recente studio epidemiologico, è stato stimato che in Brasile l’1,9% della popolazione si identifica come non binaria e lo 0,69% come transgender [7], che corrisponderebbe a circa 1,4 milioni di transgender. 

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Psychological Assessment of a sample of women with ADPKD: quality of life, body image, anxiety and depression

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Giulia Bruna Delli Zotti

Giulia Bruna Delli Zotti1,6, Eleonora Sangiovanni1, Elena Brioni3, Maria Monica Ratti1,6, Maria Teresa Sciarrone Aliprandi2, Donatella Spotti2, Paolo Manunta4,6, Lucio Sarno5,6

1 Servizio di Psicologia Clinica e della Salute, IRCCS Ospedale San Raffaele, Milano, Italia
2 MD, U.O Nefrologia Dialisi e Ipertensione, IRCCS Ospedale San Raffaele, Milano, Italia
3 Infermiera di Ricerca, U.O Nefrologia Dialisi e Ipertensione, IRCCS Ospedale San Raffaele, Milano, Italia
4 Primario U.O Nefrologia Dialisi e Ipertensione, IRCCS Ospedale San Raffaele, Milano, Italia
5 Primario Servizio di Psicologia Clinica e della Salute, IRCCS Ospedale San Raffaele, Milano, Italia
6 Università Vita Salute San Raffale, Milano, Italia

Corrispondenza a:
Giulia Bruna Delli Zotti
Servizio di Psicologia Clinica e della Salute
IRCCS Ospedale San Raffaele
Via Olgettina 60, 20132 Milano
Tel: 02.2643.6173/3446
Email: dellizotti.giuliabruna@hsr.it

 

Abstract

Introduction: The Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a chronic renal disease that has not yet been the subject of psychological research. There are only a few studies related to the consequences and complications of this pathology on female patients, although women affected by this disease present serious problems.

Aim: The purpose of this study is to perform a psychological assessment (quality of life, anxiety, depression, body image) on a sample of 37 women with ADPKD.

Materials and Methods: The assessment is based on ad hoc social and personal record, KDQOL-SF (to evaluate health-related quality of life), HADS (for anxiety and depression) and BUT (for perceived body image). This assessment is administrated in a specific outpatient clinic.

Results: Results show that kidney disease has a negative impact on health-related quality of life. Concerns about body image are linked to anxious and depressive symptomatology: an increase in these concerns is related to a worsening of anxiety and depressive symptoms in patients. Moreover, a higher psychological malaise emerges in hypertensive ADPKD patients, in terms of mood and quality of life, compared to those without this concomitant pathology. Finally, it is important to note that social support, real or perceived, is of paramount importance in maintaining psychological well-being.

Conclusions: The psychological evaluation of ADPKD patients can be used in clinical practice as a supplemental model in multidisciplinary Nephrology team.

 

Keywords: Quality of life, ADPKD, body image, psychological assessment, hypertension.

Sorry, this entry is only available in Italian.

Introduzione

Nel corso degli ultimi anni, la collaborazione dello Psicologo Clinico con le Unità Operative di Nefrologia e Dialisi si è consolidata tanto da promuovere lo sviluppo della Psiconefrologia [1]. Tale disciplina ha l’obiettivo di identificare precocemente la presenza di situazioni di disagio psicologico legate alle patologie renali croniche e di agire su quest’ultime, con interventi di supporto psicologico il più possibile specializzati. 

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Between old and new targets: blood pressure control in hypertensive outpatients

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Antonio Del Giudice

Antonio Del Giudice1, Andrea Fontana2, Antonio Cicchella1, Claudio Carmine Guida1, Antonio Gesuete1, Rachele Grifa1, Antonio Mangiacotti1, Filomena Miscio1, Matteo Piemontese1, Michele Prencipe1, Michele Vergura1, Massimiliano Copetti2, Filippo Aucella1

1Dipartimento di Scienze Mediche, Struttura Complessa di Nefrologia e Dialisi e Centro per l’Ipertensione Arteriosa, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italia
2Unità di Biostatistica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italia

Autore corrispondente:
Antonio Del Giudice
S.C. di Nefrologia e Dialisi e Centro per l’Ipertensione Arteriosa
IRCCS Casa Sollievo della Sofferenza
Viale Cappuccini
71013 San Giovanni Rotondo, Italia
Tel. 0882410397 / Fax. 0882410944
E-mail: a.delgiudice@operapadrepio.it

 

Abstract

Objective. In developed countries, blood pressure (BP) control has increased over the past few decades and is now approaching 70% of patients. Herewith we report the results of a cross-sectional study carried out on hypertensive outpatients.

Design and methods. In a cohort of 1,412 consecutive hypertensive outpatients (790 females, 622 males; mean age: 60.3±12.2 years) evaluated from January 2015 to December 2016, the following parameters were assessed: age, gender, body mass index (BMI), waist circumference (WC), smoking habits, BP in the sitting position, estimated glomerular filtration rate (eGFR), serum glucose, lipid profile, antihypertensive drugs prescribed. In agreement with the European guidelines, hypertension was defined as sitting BP ≥140/90 mmHg or use of antihypertensive drugs. Patients whose BP was <140/90 mmHg were considered as having achieved BP control. Furthermore, in compliance with the redefinition of hypertension suggested by the American College of Cardiology/American Heart Association (ACC/AHA), a second level of BP control (BP <130/80 mmHg) was evaluated.

Results. Overall, 75.7% of hypertensive patients achieved BP levels <140/90 mmHg, while 50.5% achieved BP levels <130/80 mmHg. In both contexts, compared with patients whose BP was not controlled, those achieving the BP targets were mainly younger and females with a lower prevalence of obesity, diabetes and chronic kidney disease. Furthermore, they also had a lower WC and a higher eGFR.

Conclusions. Nearly 76% of patients achieved the BP target of <140/90 mmHg, a result which is higher than the 70% achieved in Europe, and 50.6% achieved that of <130/80 mmHg, a result which is slightly higher than the 47% recently reported in USA.

Keywords: Blood pressure, blood pressure control, hypertension.

Sorry, this entry is only available in Italian.

Introduzione

L’ipertensione arteriosa è uno dei maggiori fattori di rischio indipendenti e modificabili per cardiopatia ischemica, scompenso cardiaco, accidenti cerebrovascolari, insufficienza renale e mortalità cardiovascolare in tutti i gruppi di età (1).

 

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Renal manifestation of Autosomal Dominant Polycystic Kidney Disease

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Marco Galliani1, Silvana Chicca1, Elio Vitaliano1, Luca Di Lullo2, Konstantinos Giannakakis3, Antonio Paone1

1UOC Nefrologia, Dialisi e Litotrissia, Ospedale Sandro Pertini, ASL RM2, Roma, Italia
2UOC Nefrologia e Dialisi, Ospedale L. Parodi Delfino, Colleferro (RM), Italia
3 Dipartimento Scienze Radiologiche, Oncologiche e Anatomo Patologiche, Università di Roma “La Sapienza”, Italia

Autore Corrispondente:
Marco Galliani
UOC Nefrologia, Dialisi e Litotrissia, Ospedale Sandro Pertini, ASL RM2
Via dei Monti Tiburtini, 385
00157 Roma, Italia
Tel. 0641433575
E-mail: marco.galliani@aslroma2.it

 

Abstract

Autosomal dominant polycystic kidney disease affects over 12 million people in the world and is the fourth cause of ESRD. It is the main monogenic kidney disease and causes the progressive formation of cysts leading to renal failure after a few decades. The main manifestations of the disease are observed even at a young age.
The early sign of ADPKD is impaired urinary concentrating capacity, due to medullary alteration by cysts, and resistance to vasopressin.
These anatomical alterations determine hyperfiltration, altered ammonium transport, nephrolithiasis, and, above all, hypertension even in pediatric age. Activation of the renin-angiotensin-aldosterone system has been shown responsible for the maintenance of high pressure values as well as the growth of cysts and renal fibrosis. Arterial hypertension would be responsible for ventricular hypertrophy.
Many recent studies have confirmed the role of pressure control, especially if rigorous, in decreasing the progression of renal disease, and the use of ACE inhibitors seems to have higher efficacy than other antihypertensive drugs.
The progression of renal disease is evidenced by the reduction of glomerular filtration which may be minimal in the early years, due to hyperfiltration, but, then, may even exceed 5 ml / min per year, especially when the total kidney volume (TKV) exceeds 1500 ml.
In more rapid progression forms, ESRD may appear at about 55 years of age. The main risk factors are age, genetic mutation, familiarity with ESRD, macrohematuria episodes, and early onset hypertension. Some authors have proposed both genetic and clinical scores that can provide guidance on the probability of rapid progression.
Other renal manifestations include kidney pain, nephrolithiasis, urinary tract infections and cyst hemorrhage. Renal cell carcinoma is a very rare event.

 

Keywords: Autosomal dominant polycystic kidney disease, hypertension, renin-angiotensin-aldosterone system, compensatory hyperfiltration, renal volume, ESRD.

Sorry, this entry is only available in Italian.

Introduzione

Il rene policistico rappresenta la malattia ereditaria monogenica più frequente in ambito nefrologico. Ne sono affetti circa 12,5 milioni di individui nel mondo ed è la quarta causa di insufficienza renale terminale dopo il diabete, l’ipertensione e le glomerulonefriti (1). 

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REPORT FOR THE WORLD KIDNEY DAYS IN ITALY 2015-2016

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Pasquale Esposito

Pasquale Esposito1, Yuri Battaglia2, Elena Caramella1, Domenico Russo3, Alessandro Balducci4 e Coordinatori locali*

1 Dipartimento di Nefrologia, Dialisi e Trapianto, Fondazione IRCCS Policlinico San Matteo e Universitàdi Pavia;
2 Unità di Nefrologia e Dialisi, Ospedale “Sant’Anna”, Ferrara;
3 UOC Nefrologia, Università “Federico”, Napoli;
4 Fondazione Italiana del Rene Onlus, Roma
* Coordinatori Locali (in ordine alfabetico):
Filippo Aucella (San Giovanni Rotondo); Deborah Avino (Vairano Scalo); Maurizio Borzumati (Verbania); Pierluigi Botti (Mantova); Franco Brizzi (Bologna); Santina Castellino (Taormina); Vincenzo Cuomo (Marano); Filippo Dagostino (Corato); Walter De Simone (Avellino); Pierluigi Di Loreto (Belluno); Fulvio Fiorini (Rovigo); Giacomo Garibotto (Genova); Giuseppe Iulianiello (San Felice a Cancello, CE); Ludovico La Peccerella (Benevento); Cosimo Mancini (Fasano); Maria Cristina Mereu (San Gavino); Mario Passaghe (Tempio Pausania); Elisabetta Prati (Desenzano del Garda); Andrea Re (Bagheria); Vincenzo Rondanini (Palmi); Ornella Pergamo (Pompei); Maria Adelina Simeoni (Catanzaro); Alda Storari (Cona); Antonio Carlini (Lucca); Agostino Tedesco (Andria); Marcello Amato (Prato); Ester Costantino (Idro); Vincenzo D’Alessandro (Afragola); Elio Montagna, Efisio Sozzo (Maglie); Carlo Lomonte, Piero Lisi (Cassano delle Murge); Renato Parsi (Alcamo); Stefano Saffiotti (Imperia); Domenico Santoro (Messina); Paola Tira, Roberta Tosini (Leno); Salvatore Gianni (Siracusa); Concetto Sessa (Siracusa); Anna Scafarto (Castellammare di Stabia); Doriana Chiarinotti (Novara); Roberto Boero (Torino); Annalisa Buonfantino (Napoli); Espedito D’Amaro, Giacomo Lus (Portici); Andrea Re (Trapani); Maria Cossu (Sassari); Marco Ballestri (Modena); Vito Gasparro (Como); Luigi Vernaglione (Mesagne).

Corrispondenza a:
Pasquale Esposito
U.O. di Nefrologia, Dialisi e Trapianto, Fondazione IRCCS Policlinico “San Matteo”
Piazzale Golgi 19, 27100 Pavia
Fax/Tel: +390382503883
e-mail: pasqualeesposito@hotmail.com

 

Abstract

World Kidney Day (WKD) is a global campaign, promoted by International Federation of Kidney Foundations (IFKF) and International Society of Nephrology (ISN) aimed at raising awareness among people on importance of our kidneys. This campaign includes many events across the globe. The main purpose of WKD is to create and spread awareness about preventive behaviours and risk factors for renal diseases. In Italy WKD is organized by the Italian Kidney Foundation (FIR) in collaboration with Italian Society of Nephrology (SIN) and the Red Cross of Italy. It takes place in hospitals, public spaces and in schools, where each participant is provided with informative material together with blood pressure and urine dipstick testing. Here, we present the data collected during the 2015 and 2016 WKD campaigns.

KEYWORDS: World Kidney Day, Prevention, Hypertension, Urinalysis

Sorry, this entry is only available in Italian.

Introduzione

La giornata mondiale del rene (GMR) è un’iniziativa internazionale che mira all’informazione e alla sensibilizzazione dell’opinione pubblica circa le patologie renali, focalizzando l’attenzione sui fattori di rischio e sulle possibilità di cura e trattamento delle stesse (1). In Italia tale evento viene organizzato dalla Fondazione Italiana del Rene (FIR), con la collaborazione della Società Italiana di Nefrologia (SIN) e la Croce Rossa Italiana (CRI). L’iniziativa, che coinvolge numerose Unità di Nefrologia distribuite sul territorio nazionale, si articola su due progetti distinti, quello che si svolge nelle piazze o negli ambulatori di Nefrologia, detto anche “progetto camper” (2, 3), e quello che si tiene nelle scuole, rivolto in particolare a studenti del quarto e quinto anno di scuola superiore.

In questo articolo riportiamo i dati ricavati dai partecipanti alla GMR negli anni 2015 e 2016.
 

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PRES (Posterior Reversible Encephalopathy Syndrome): Potential complication of hypertensive crisis. Case report and literature review

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Michele Vergura

Vergura Michele1, Prencipe Michele1, Del Giudice Antonio Maria1, Grifa Rachele1, Miscio Filomena1, Pennelli Anna Maria2, Popolizio Teresa2, Simeone Anna2, Ferrare Mariangela3, Leone Maurizio3, Aucella Filippo1

1 Struttura Complessa di Nefrologia e Dialisi IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG)
2 Dipartimento di Diagnostica per Immagini IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG)
3 Struttura Complessa di Neurologia IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo (FG)

Autore Corrispondente:
Vergura Michele
Struttura Complessa Nefrologia e Dialisi  IRCCS “ Casa Sollievo della Sofferenza “,
V.le Cappuccini, 1, 71013 San Giovanni Rotondo
Tel: 0882 410293
Fax: 0882 410208
Email: m.vergura@operapadrepio.it

 

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological syndrome, usually reversible, characterized by vasogenic oedema in cerebral posterior regions in patients with autoimmune diseases, nephropathies, hypertensive crisis, eclampsia and exposure to cytotoxic drugs. The main symptoms are: headache, nausea, vomiting, seizures, visual disturbance and altered consciousness. Complications as cerebral hemorrhage and recurrences are rare.

We describe a case of a 65 years old woman, affected by chronic kidney disease, recently exacerbated, diabetes and hypertension in treatment, who showed an heterogeneous clinical presentation with vomiting, headache, blurred vision and impaired consciousness during an episode of acute hypertension. After an adjustement of the antihypertensive treatment we observed a regression of symptoms in one week. FLAIR sequences on MRI showed cerebral bilateral vasogenic oedema in posterior regions, typical for PRES. This case was suggestive for PRES and a prompt adjustement of the antihypertensive treatment was critical for clinical recovery. Brain MRI was crucial for diagnosis. It is important for clinicians to recognize PRES as a possible complication of renal disease and hypertensive crisis.

Key words: Chronic kidney disease, Hypertension, Magnetic Resonance Imaging, Posterior reversible encephalopathy syndrome

Sorry, this entry is only available in Italian.

INTRODUZIONE

La PRES è una entità clinico-radiologica descritta per la prima volta nel 1996 da Hinchey e coll. (1) sulla base di 15 casi clinici. Nel corso degli anni è stata contrassegnata da diversi acronimi e sigle tra cui leucoencefalopatia posteriore reversibile, sindrome dell’edema cerebrale posteriore reversibile, encefalopatia parieto-occipitale reversibile, ma PRES è l’acronimo generalmente accettato. Tuttavia, ancora recentemente, tale definizione è stata rimessa in discussione poiché si è documentato un tasso di mortalità fino al 15% (2–3). Descritta in corso di crisi ipertensive, disordini immunitari, terapie antirigetto e malattia renale cronica, essa è caratterizzata dall’associazione variabile di crisi epilettichecefalea  disturbi del visus, nausea, vomito e segni neurologici focali in un contesto quasi costante di scarso controllo della pressione arteriosa. Il segno distintivo di questa condizione è la presenza di edema cerebrale vasogenico, a patogenesi non completamente chiarita ma, verosimilmente associata ad una alterazione dei meccanismi di autoregolazione del flusso ematico cerebrale da parte dell’unità neuro vascolare, che predomina nel circolo cerebrale posteriore. Pertanto il gold standard per la diagnosi è la risonanza magnetico nucleare (RMN) specie nelle sequenze “ fluid-attenuated inversion recovery (FLAIR)”  la cui diffusione ha contribuito all’aumento della frequenza della diagnosi.Tipicamente è una malattia reversibile, una volta che la causa è rimossa o sotto controllo, risolvendosi clinicamente e radiologicamente in un lasso di tempo estremamente variabile e difficilmente prevedibile. Tuttavia, l’esito non è sempre favorevole, possono reliquare esiti importanti e a volte, in presenza di coma o stato epilettico, è necessario il trattamento in un reparto di terapia intensiva. Si descrive il caso clinico di una paziente con evoluzione clinica paradigmatica della PRES.
 

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