ESPN 51th Annual Meeting

ESPN 2018


 
A Case of Atypical Acute Poststreptococcal Glomerulonephritis Associated with PRES
HÜSEYIN DAĞ 1 TUĞÇE AKSU UZUNHAN 2 GIZEM GÜVENER 1 AHMET İRDEM 3 HASAN DURSUN 4

1- HEALTH SCIENCES UNIVERSITY, OKMEYDANI EDUCATION AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRICS
2- HEALTH SCIENCES UNIVERSITY, OKMEYDANI HEALTH PRACTICE AND RESEARCH CENTER, DEPARTMENT OF PEDIATRIC NEUROLOGY
3- HEALTH SCIENCES UNIVERSITY, OKMEYDANI HEALTH PRACTICE AND RESEARCH CENTER, DEPARTMENT OF PEDIATRIC CARDIOLOGY
4- HEALTH SCIENCES UNIVERSITY, OKMEYDANI HEALTH PRACTICE AND RESEARCH CENTER, DEPARTMENT OF PEDIATRIC NEPHROLOGY
 
Introduction:

 Posterior Reversible Encephalopathy Syndrome (PRES) is characterized by headache, abdominal pain, convulsions, stroke, and visual loss. Here we report a case of atypical acute poststreptococcal glomerulonephritis and PRES presenting with convulsion.

Material and methods:

 A 9-year-old girl was referred to our Pediatric Emergency Unit with headache, decreased vision, fatigue, throwing in the right eye, slipping in the eyes and recurrent convulsion. The patient was hospitalized. Physical examination revealed a axillar temperature of 36.5 °C, weight 39 kg (90-97 p), height 136 cm (75 p), blood pressure 110/70 mmHg (<90 p), pulse rate 90/min and respiratory rate 22/min. The patient had no edema and no pathological findings in other system examinations. Renal function tests and liver function tests were normal. Vasogenic edema was detected in contrasted brain MR and MR angiography. This view was consistent with PRES. On the third day of hospitalization, the patient complained of macroscopic hematuria. It was learned that the patient had upper respiratory tract infection 3 weeks before her admission. In the urinalysis of the patient, there were protein (++), blood (+++), and erythrocyte 237/mm3, leucocyte 9/mm3 at the microscopic examination. C3 35 mg/ L, C4 25 mg/dL, ASO 560 U/mL, ANA and anti-dsDNA were negative.  The proteinuria of the patient was 8.4 mg/m2/h and the protein/creatinine ratio was 0.38. Although hypertension was not detected at the beginning, acute poststreptococcal glomerulonephritis and hypertensive encephalopathy and PRES were considered due to macroscopic hematuria, low C3 and high ASO levels. 

Results:

 The patient undergoing furosemide did not have convulsions. The patient was completely normal on the fourth day of the treatment.

Conclusions:

 The major anomaly in PRES is cerebral vasogenic edema. Encephalopathy is a disease that should be kept in mind in children with seizures and kidney involvement. Delay in diagnosis and treatment may cause permanent neurological damage.