A rare case of hemodialysis-related portosystemic encephalopathy and review of the literature

Acta Clin Belg. 2020 Aug;75(4):296-300. doi: 10.1080/17843286.2019.1595836. Epub 2019 Mar 28.

Abstract

Hemodialysis-related portosystemic encephalopathy (HRPSE) is a clinical phenomenon where portosystemic encephalopathy (PSE) develops without liver dysfunction, usually caused by changes in the portosystemic blood flow related to hemodialysis. We describe the case of a 22-year old patient with a transjugular intrahepatic portosystemic shunt (TIPS) who developed HRPSE several months after initiation of hemodialysis. Despite initial therapy with laxatives and neomycin symptoms recurred. It was only after relocation of the hemodialysis catheter from the superior caval vein to the femoral vein that symptoms completely resolved.

Keywords: Portosystemic encephalopathy; TIPS; hemodialysis; shunt.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Brain / diagnostic imaging
  • Femoral Vein
  • Gastrointestinal Agents / therapeutic use
  • Glucocorticoids / administration & dosage
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / physiopathology
  • Hepatic Encephalopathy / therapy
  • Humans
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / therapy*
  • Lactulose / therapeutic use
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / congenital*
  • Magnetic Resonance Imaging
  • Male
  • Polycystic Kidney, Autosomal Recessive / complications
  • Portasystemic Shunt, Transjugular Intrahepatic*
  • Renal Dialysis / adverse effects*
  • Vena Cava, Superior
  • White Dot Syndromes / complications
  • White Dot Syndromes / drug therapy*
  • Young Adult

Substances

  • Gastrointestinal Agents
  • Glucocorticoids
  • Lactulose