title: Use of a polysulfone hemodialysis membrane may prevent recurrent posterior reversible encephalopathy syndrome in a patient undergoing hemodialysis.
abstract: A 71-year-old woman underwent hemodialysis (HD) treatment for chronic kidney disease. During HD, she developed headache, abnormalities in visual perception, and generalized convulsion. Brain magnetic resonance imaging (MRI) showed T2-hyperintensity lesions in the posterior lobe, and an electroencephalogram showed slow waves in all areas. Twenty days later, the T2-hyperintensity lesions had vanished. Furthermore, perfusion computed tomography (CT) and single-photon emission CT with N-isopropyl[(123)I]-p-iodoamphetamine (IMP-SPECT) showed no significant abnormalities. The patient was diagnosed with posterior reversible encephalopathy syndrome (PRES) because she displayed typical clinical symptoms and MRI findings. Although several antihypertensive and antiseizure medications were administered, the patient experienced recurrent PRES. Therefore, we used a polysulfone dialyzer to reduce the oxidative stress and inflammation while preserving vascular endothelial function. After use of a polysulfone dialyzer membrane, the patient had no PRES episodes during the clinical course. This is the first study to demonstrate that use of a polysulfone dialyzer membrane instead of a cellulose membrane may prevent recurrent PRES.
authors.affiliation: Department of Nephrology, Graduate School of Medicine, Institute of Health Biosciences, University of Tokushima, Tokushima, 770-8503, Japan, akiramima@clin.med.tokushima-u.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Mima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsubara
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Endo
authors.forename: Taichi
authors.initials: T
authors.lastname: Murakami
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Hashimoto
mesh_terms: D000368:Aged; D001672:Biocompatible Materials; D005260:Female; D006801:Humans; D007249:Inflammation / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008567:Membranes, Artificial; D018384:Oxidative Stress; D011108:Polymers; D054038:Posterior Leukoencephalopathy Syndrome / Q000175:diagnosis / Q000517:prevention & control*; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D051436:Renal Insufficiency, Chronic / Q000628:therapy; D055502:Secondary Prevention; D013450:Sulfones
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D011108:Polymers; D013450:Sulfones; C017662:polysulfone P 1700