Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review,Pediatric Nephrology

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Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2021-09-21 , DOI: 10.1007/s00467-021-05244-z
Corinne Orlando ₁ , Gregorio P Milani _{2,

3} , Giacomo D Simonetti _{4,

5} , Barbara Goeggel Simonetti _{4,

5,

6} , Sebastiano A G Lava ₇ , Rolf Wyttenbach _{5,

8,

9} , Mario G Bianchetti _{1,

5} , Marirosa Cristallo Lacalamita ₈

Affiliation

Background

Kidney diseases are a recognized cause of posterior reversible leukoencephalopathy syndrome, usually abbreviated as PRES. The purpose of this review was to systematically address the association between acute postinfectious glomerulonephritis and PRES.

Methods

We performed a systematic review of the literature on acute postinfectious glomerulonephritis associated with PRES. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Systematic Reviews and Meta-analyses were used. Databases searched included Excerpta Medica, US National Library of Medicine, and Web of Science.

Results

For the final analysis, we evaluated 47 reports describing 52 cases (32 males and 20 females). Fifty patients were ≤ 18 years of age. Blood pressure was classified as follows: normal-elevated (n = 3), stage 1 hypertension (n = 3), stage 2 hypertension (n = 5), and severe hypertension (n = 41). Acute kidney injury was classified as stage 1 in 32, stage 2 in 16, and stage 3 in four cases. Neuroimaging studies disclosed a classic posterior PRES pattern in 28 cases, a diffuse PRES pattern in 23 cases, and a brainstem-cerebellum PRES pattern in the remaining case. Antihypertensive drugs were prescribed in all cases and antiepileptic drugs in cases presenting with seizures. A resolution of clinical findings and neuroimaging lesions was documented in all cases with information about follow-up.

Conclusions

The main factor associated with PRES in acute postinfectious glomerulonephritis is severe hypertension. Prompt clinical suspicion, rapid evaluation, and management of hypertension are crucial.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

中文翻译：

与急性感染后肾小球肾炎相关的后部可逆性白质脑病综合征：系统评价

背景

肾脏疾病是后部可逆性白质脑病综合征的公认原因，通常缩写为 PRES。本综述的目的是系统地探讨急性感染后肾小球肾炎与 PRES 之间的关联。

方法

我们对与 PRES 相关的急性感染后肾小球肾炎的文献进行了系统评价。使用了经济和社会研究委员会关于进行叙述性综合以及系统评价和荟萃分析的首选报告项目指导建议的原则。搜索的数据库包括 Excerpta Medica、美国国家医学图书馆和 Web of Science。

结果

对于最终分析，我们评估了描述 52 例（32 名男性和 20 名女性）的 47 份报告。50 名患者年龄≤18 岁。血压分为以下几类：正常升高（n = 3）、1 期高血压（n = 3）、2 期高血压（n = 5）和重度高血压（n = 41)。急性肾损伤分为 1 期 32 例，2 期 16 例，3 期 4 例。神经影像学研究显示 28 例为典型的后部 PRES 模式，23 例为弥漫性 PRES 模式，其余病例为脑干-小脑 PRES 模式。在所有病例中均开具抗高血压药物，在出现癫痫发作的情况下开具抗癫痫药物。在所有病例中记录了临床发现和神经影像学病变的解决，并提供了有关随访的信息。