Kürşat Bora ÇARMAN, Belde KASAP, Ulaç YİŞ

Posterior reversibl ansafalopati sendromu gelişen bir akut post-streptokoksik glomerülonefrit olgusu

On yaşında erkek olgu tonsillit tedavisinden sekiz gün sonra yüzde, bacaklarda ve skrotal bölgede şişlikler nedeniyle baş- vurdu. İdrar tetkikinde hematüri ve nefrotik düzeyde protei- nüri gözlenen, üre, kreatinin, lipit profili ve anti-streptolizin O antikor değerleri yüksek, albümin ve C3 değeri değeri dü- şük, 24 saatlik idrar tetkikinde proteinürisi saptanan olguda akut post-streptokoksik glomerulonefrit (APSGN) düşünül- dü. Böbrek biyopsisi APSGN ile uyumlu bulundu. İzlemin- de antihipertansif ve diüretik tedavisi altında ve kan basıncı 130/80 mmHg (hasta için 99 persantil: 129/88 mmHg) iken şiddetli başağrısı, kusma ve konvülziyon gözlendi. İzleminde kan basıncı değerleri 160/90 mmHg düzeyine yükseldi. Çe- kilen elektroansefalografi (EEG) normal, manyetik rezonans görüntüleme (MRG) bulguları posterior reversibl ensafalopa- ti sendromu (PRES) ile uyumlu bulundu. Antihipertansif ve antikonvülzan tedavi sonrası birinci ayda MRG normal sap- tandı. Hasta izleminin birinci yılında kan basıncı, nörolojik muayenesi ve idrar bulguları normal olarak izlenmektedir. Olgumuz, PRESin kan basıncının yükselme seyrinde ve çok yüksek olmayan kan basıncı değerlerinde de karşımıza çıka- bileceğine dikkat çekmek üzere sunulmuştur. (Türk Ped Arş 2014; 49: 348-52)

A case of acute post-streptococcal glomerulonephritis that developed posterior reversible encephalopathy syndrome

A 10-year male patient presented with swelling in the face, legs and scrotal area which developed 8 days after tonsilli- tis treatment. Acute post-sterotococcal glomerulonephritis (APSGN) was considered in the patient whose urinalysis re- vealed hematuria and proteinuria at nephrotic level, whose urea, creatinine, lipid profile and anti-streptolysine O anti- body levels were increased, albumin and C3 value were dec- reased and whose 24-hour urine test revealed proteinuria. Renal biopsy was found to be compatible with APSGN. In the follow-up, severe headache, vomiting and convulsion were observed under antihypertensive and diuretic treatment and when the blood pressure was 130/80 mmHg (the 99th per- centile for the patient: 129/88 mmHg). During the follow-up, the blood pressure values increased to 160/90 mmHg. The electroencephalogram (EEG) performed was found to be nor- mal and magnetic resonance imaging (MRI) findings were compatible with posterior reversible encephalopathy syndro- me (PRES). MRI was found to be normal at the first month following antihypertensive and anticonvulsive treatment. In the first year of the follow-up, the blood pressure, neurolo- gical examination and urinalysis findings were found to be normal. This patient was presented to draw attention to the fact that PRES can also present with a blood pressure tending to increase and with blood pressure values which are not so high. (Türk Ped Arş 2014; 49: 348-52)

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