Posterior reversible encephalopathy syndrome in rapid progressive glomerulonephritis

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological syndrome affecting the posterior cerebral regions and is associated with an accelerated rise in blood pressure, renal disease or autoimmune disorders. Our objective was to review the association of PRES with renal outcome. Materials and Methods: Retrospective review of all nephrology patients diagnosed with PRES from 2010 to 2013 at our institution. The diagnosis of PRES was based on the presence of clinical features such as headache, altered mental status, visual disturbances and seizures with positive radiological findings on either Magnetic Resonance Imaging or Computed Tomography of the brain. Their demographic and laboratory result were analysed in particular, progression to end stage renal disease (ESRD). Results: Seven patients (3 males: 4 females), median age of 21 (IQR 17-24) years were recruited. Majority had lupus nephritis except one patient who had crescenteric IgA nephropathy. Median duration of their disease was 52.83 (IQR 3.3 – 58.17) months. Mean systolic and diastolic blood pressure were 186.43 ± 18.87 and 110.43 ± 14.02 mm Hg. Mean serum albumin and creatinine were 27.3 ± 8.7 g/L and 403.4 ± 183.6 umol/L respectively, at presentation. Two patients developed ESRD at the development of PRES whereas three patients progressed to ESRD at 2.73, 5.77 and 17.13 months. The other two patients had complete recovery of renal function to normal levels. All patients had full neurological recovery within one week. Conclusion: Development of PRES in patients with underlying chronic kidney disease may be a predictor of poor renal survival.