Pediatric Nephrology

, Volume 27, Issue 3, pp 375–384 | Cite as

Posterior reversible encephalopathy syndrome in children with kidney diseases

  • Kenji Ishikura
  • Yuko Hamasaki
  • Tomoyuki Sakai
  • Hiroshi Hataya
  • Robert H. Mak
  • Masataka Honda
Educational Review


Posterior reversible encephalopathy syndrome (PRES) was originally used to describe a reversible, predominantly posterior leukoencephalopathy in patients who had renal insufficiency, hypertension, or who received immunosuppressive therapy. Since PRES is prevalent in children with kidney diseases, awareness and understanding of it is important for practicing pediatric nephrologists. A comprehensive approach to the diagnosis of PRES includes thorough determination of predisposing factors, clinical symptoms, and mandatory appropriate imaging. Unfortunately, the pathophysiology of PRES is still obscure and specificity of radiological examination has not yet been established. Two major predisposing factors, namely hypertension and calcineurin inhibitors, are well recognized. In addition, nephrotic syndrome is a common underlying condition for development of PRES. Frequent symptoms include altered consciousness (coma, stupor, lethargy, confusion), seizure, headache, and visual disturbance. Most of these symptoms usually develop abruptly and resolve within a few weeks after proper management. Cranial magnetic resonance (MR) imaging is the first-line modality of imaging studies for detecting PRES. Diffusion-weighted imaging with quantification of apparent diffusion coefficient (ADC) values by ADC mapping may provide more accurate and specific images in the future.


Encephalopathy Reversible Children Kidney diseases Nephrotic syndrome Hypertension Cyclosporine 



The authors would like to thank Dr. Shuichi Ito, Dr. Tatsuo Kono, Dr. Tomohide Goto, and Dr. Sahoko Miyama who provided generous advice in preparing the manuscript.


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Copyright information

© IPNA 2011

Authors and Affiliations

  • Kenji Ishikura
    • 1
  • Yuko Hamasaki
    • 1
  • Tomoyuki Sakai
    • 1
  • Hiroshi Hataya
    • 1
  • Robert H. Mak
    • 2
  • Masataka Honda
    • 1
  1. 1.Department of NephrologyTokyo Metropolitan Children’s Medical CenterFuchu-city, TokyoJapan
  2. 2.Division of Pediatric Nephrology, Rady Children’s HospitalUniversity of CaliforniaSan DiegoUSA

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