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Association between renal insufficiency and lesion characteristics of posterior reversible encephalopathy syndrome

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Abstract

Background

Posterior reversible encephalopathy syndrome (PRES) is characterized by cerebral blood flow dysregulation and the blood–brain barrier (BBB) disruption. While renal insufficiency has been considered a factor in BBB fragility, the relationship between renal insufficiency and the PRES lesions volume remains unclear.

Methods

This observational study was performed retrospectively. PRES patients were categorized into two groups with renal insufficiency, defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2 on the day of symptom occurrence. Lesion volume was measured using fluid-attenuated inversion recovery (FLAIR) imaging, and the brain was divided into nine regions. The volume of the parietal-occipital-temporal lobe was considered typical, while the other six regions were labeled as atypical.

Results

The study included 200 patients, of whom 94 (47%) had renal insufficiency. Patients with renal insufficiency had a larger lesion volume (144.7 ± 125.2 cc) compared to those without renal insufficiency (110.5 ± 93.2 cc; p = 0.032); particularly in the atypical lesions volume (49.2 ± 65.0 vs. 29.2 ± 44.3 cc; p = 0.013). However, there was no difference in the reversibility of the lesions (35.2 ± 67.5 vs. 18.8 ± 33.4 cc; p = 0.129). Multiple regression analysis revealed that decreases in eGFR (β = -0.34, 95% CI -0.62-0.05, p = 0.020) were positively associated with total lesion volume.

Conclusion

Our findings suggest that PRES patients with renal insufficiency experience more severe lesion volumes, likely due to the atypical brain regions involvement. The lesions involving atypical regions may have a similar pathophysiology to typical lesions, as the PRES lesions reversibility was found to be similar between individuals with and without renal insufficiency.

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Data availability

Upon a reasonable request, the corresponding author can provide the data supporting the findings of this study.

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Funding

This work was supported by the Brain Convergence Research Program of the National Research Foundation (NRF) funded by the Korean government (MSIT) (No.2020M3E5D2A01084576) and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2020R1A2C2100077). The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the Article.

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Authors and Affiliations

  1. School of Convergence Science and Technology, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea

    Dong Young Jeong

  2. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jun Young Chang, Dong-Wha Kang, Sun U. Kwon & Bum Joon Kim

  3. Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Yea Na Shin

  4. Department of Neurology, Gil Medical Center, Gachon College of Medicine, Incheon, Republic of Korea

    Sang Hee Ha

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  1. Dong Young Jeong
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Contributions

Writing—original draft preparation: Dong Young Jeong, MD, Bum Joon Kim MD, PhD. Writing – review and editing: Dong Young Jeong, MD, Bum Joon Kim MD, PhD, Sang Hee Ha MD, PhD, Jun Young Chang, MD, PhD, Dong-Wha Kang, MD, PhD, Sun U Kwon MD, PhD. Data curation: Dong Young Jeong, MD, Bum Joon Kim MD, PhD. Conceptualization: Dong Young Jeong, MD, Bum Joon Kim MD, PhD, Yea Na Shin, MD, Sang Hee Ha MD, PhD, Jun Young Chang, MD, PhD, Dong-Wha Kang, MD, PhD, Sun U Kwon MD, PhD. Methodology & Formal analysis and investigation: Dong Young Jeong, MD, Bum Joon Kim MD, PhD, Yea Na Shin, MD, Sang Hee Ha MD, PhD, Jun Young Chang, MD, PhD, Dong-Wha Kang, MD, PhD, Sun U Kwon MD, PhD. Funding acquisition: Bum Joon Kim MD, PhD. Supervision: Bum Joon Kim MD, PhD.

Corresponding author

Correspondence to Bum Joon Kim.

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Ethics approval

The study was approved by the local ethics committee (IRB number: 2021–1843), which waived the need for informed consent due to the retrospective nature of the study.

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The authors declare that they have no conflict of interest.

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Jeong, D.Y., Shin, Y.N., Ha, S.H. et al. Association between renal insufficiency and lesion characteristics of posterior reversible encephalopathy syndrome. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07446-3

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