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Renal Allograft Alıcısı Çocuk Hastada Takrolimus İlişkili Geri Dönüşümlü Posterior Ensefalopati Sendromu

Posterior Reversible Encephalopathy Related to Tacrolimus in a Pediatric Renal Allograft Recipient

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2012
DOI: 
DOI 10.5262/tndt.2012.1002.14

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity characterized by headache, altered mental state, seizure, visual disturbance and characteristic magnetic resonance imaging (MRI) findings. A 15-year-old boy, who had renal transplantation three weeks previously because of Prune Belly syndrome presented with headache, weakness and altered consciousness level. He was on tacrolimus, mycophenolat mofetil and prednisolone therapy. He suffered a generalized tonicclonic seizure at the emergency room. He had significant visual disturbance and headache on postictally. Serum creatinine was 1.2 mg/dl and tacrolimus trough level was 15 ng /ml. Serum electrolytes, glucose, liver enzymes, calcium, phosphate, albumin, magnesium, and acid-base status were all normal. Lumbar puncture findings were normal. Cranial MRI was compatible with PRES. It was thought to be due to tacrolimus therapy; the medication was therefore switched to cyclosporine, which improved the clinical situation. The majority of lesions on magnetic resonance imaging disappeared within 5 weeks. Transplantation teams should be aware of this uncommon complication of immunosuppression, which may be associated with significant morbidity and mortality if it is not expeditiously recognized.
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Abstract (Original Language): 
Geri dönüşümlü posterior ensefalopati sendromu (PRES) baş ağrısı, mental durum değişiklikleri, konvülziyon, görme bozuklukları ve tipik kraniyal manyetik rezonans görüntüleme (MRG) bulguları ile karakterize, klinikoradyolojik bir antitedir. Prune Belly sendromuna ikincil son dönem böbrek yetmezliği olan ve babadan renal transplantasyon yapılarak steroid, takrolimus ve mikofenolat mofetil tedavisi başlanan 15 yaşında erkek çocuk, nakilden 3 hafta sonra baş ağrısı, halsizlik ve çevreye ilgisizlik yakınmaları ile getirildi. Başvuru sırasında vital fonksiyonları stabil bulundu. Acil serviste değerlendirilmesi devam ederken tonik – klonik jeneralize konvülziyon geçirdi. Nöbet sonrası dönemde görme bozukluğu ve başağrısı ortaya çıktı. Serum kreatinin 1.2 mg/dl, serum takrolimus düzeyi 15 ng/ml olarak bulundu. Serum elektrolitleri, glukoz, karaciğer fonksiyon testleri, kalsiyum, fosfor, magnezyum, albumin normal bulundu; beyin omurilik sıvısı incelemesinde patolojik bulgu saptanmadı. Kranial MRG bulguları PRES ile uyumlu bulundu. Almakta olduğu takrolimus tedavisi kesilerek siklosporin tedavisine geçildi. Tedavi değişikliğinin 5. haftası ve 4. ayında yapılan kontrol kranial MRG’de patolojik bulguların belirgin olarak gerilediği görüldü. Erken tanı konulup gerekli önlemler alınmadığı takdirde kalıcı beyin hasarına yol açabileceğinden, renal transplant hastalarında gelişen ani bilinç değişikliklerinde bu sendromun akla getirilmesi gerektiği düşüncesindeyiz.
FULL TEXT (PDF): 
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  • 2
181-184
  • Turkish

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