Document Detail

Hemodialysis-related portal-systemic encephalopathy.
MedLine Citation:
PMID:  15332238     Owner:  NLM     Status:  MEDLINE    
The authors encountered a case of portal-systemic venous shunt newly diagnosed after initiation of hemodialysis. A 68-year-old Japanese woman began hemodialysis because of symptoms of uremia including loss of appetite and pulmonary edema. Loss of consciousness occurred suddenly after her ninth session of hemodialysis. No hepatic functional abnormality was found other than hyperammonemia (314 microg/dL [184 micromol/L]). Loss of consciousness subsequently occurred often after hemodialysis. Color Doppler ultrasonography and magnetic resonance angiography depicted a large shunt between the left gastric vein and left renal vein resulting in portal flow entering the systemic circulation via the renal vein. Because the shunt was large, ligation of it was performed surgically. Results of histologic examination of a liver biopsy specimen obtained intraoperatively were normal. The patient became well postoperatively. This patient's encephalopathy appeared to be caused by the flow of ammonia-rich portal venous blood into the systemic circulation via the large shunt owing to a decrease in intravenous pressure after rapid hemodialysis. Portal-systemic shunt encephalopathy should be recognized as a "new" neuropsychiatric disorder characteristic of patients undergoing hemodialysis.
Yoshifumi Ubara; Jyunichi Hoshino; Tetsuo Tagami; Naoki Sawa; Hideyuki Katori; Fumi Takemoto; Masamichi Matsuda; Shigeko Hara; Kenmei Takaichi
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  44     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-27     Completed Date:  2005-02-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e38-42     Citation Subset:  IM    
Nephrology Center, Toranomon Hospital, Tokyo, Japan.
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MeSH Terms
Hepatic Encephalopathy / diagnosis,  etiology*,  surgery
Portasystemic Shunt, Surgical
Renal Dialysis / adverse effects*

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