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Kidney Week

Abstract: PO2327

Evaluating the Role of the Kidneys in Posterior Reversible Encephalopathy Syndrome in Pediatric Patients

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Shah, Shruti, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
  • South, Andrew M., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Kidney disease is a known risk factor for posterior reversible encephalopathy syndrome (PRES), but the specific markers of kidney function that are relevant to PRES are undescribed. The objective was to investigate the associations of various markers of kidney function with PRES.

Methods

In a case-control study of high-risk children, we recorded most-recent blood urea nitrogen (BUN), documentation of acute kidney injury (AKI), serum creatinine, serum albumin, and hemoglobin level and calculated the estimated glomerular filtration rate (eGFR). PRES cases were confirmed clinically and radiologically. We applied multivariable regression models to estimate the associations of the exposures with PRES. We utilized directed acyclic graphs to inform the following model adjustments: 1) history of kidney disease and nephrotoxic medication exposure for the kidney function models; 2) history of kidney disease, eGFR, and albumin treatment for the serum albumin model; and 3) age, sex, history of kidney disease, eGFR, fluid overload, and nephrotoxic medication exposure for the hemoglobin model.

Results

The mean age of the study population was 9.5 years (±4.9) and 51% were female. Of that population, 29% had a history of kidney disease, 67% had exposure to nephrotoxic medications, and 29% had AKI prior to the onset of PRES. BUN [adjusted OR (aOR) 1.03 per 1 mg/dl increase, 95% CI 0.99-1.07, p=0.09] and AKI (aOR 3.78, 0.68-21.13, p=0.13) were modestly associated with PRES. eGFR (aOR 1.0 per 1 ml/min/1.73 m2 increase, 0.98-1.01, p=0.55), albumin (aOR 1.7 per 1 g/dl increase, 0.73-3.93, p=0.22) and hemoglobin (aOR 1.12 per 1 g/dl increase, 0.81-1.56, p=0.48) were not associated with PRES.

Conclusion

In a case-control study of children at high risk for PRES, we demonstrated that among several markers of kidney function, BUN and AKI were modestly associated with PRES. Further prospective studies with larger sample sizes and higher power are necessary to fully evaluate the role of kidney function in the development of PRES.

Funding

  • Other NIH Support