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 CASE REPORT
Year : 2022  |  Volume : 32  |  Issue : 2  |  Page : 179-181

Hemodialysis-related portal-systemic encephalopathy: A rare cause of recurrent encephalopathy among patients on maintenance hemodialysis


1 Department of Nephrology, Aster MIMS Hospital, Kozhikode, Kerala, India
2 Department of Nephrology, Aster MIMS Hospital; Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India
3 Department of Radiodiagnosis, Aster MIMS Hospital, Kozhikode, Kerala, India
4 Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

Correspondence Address:
Feroz Aziz
Department of Nephrology, Aster MIMS Hospital, Kozhikode, Kerala, India. Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijn.IJN_314_20

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Portal-systemic venous shunts can rarely develop without any intrinsic liver diseases. However, the cause of shunt formation in these cases are not very clear. Literature suggests that hemodialysis can precipitate symptoms in patients with asymptomatic portal-systemic venous shunts (PSVS). Rare presentations of recurrent encephalopathy due to PSVS in the absence of liver dysfunction has been described in patients undergoing hemodialysis. We report a rare case of recurrent Hemodialysis Related Porto-Systemic Encephalopathy (HRPSE) in a 50-year old male during maintenance hemodialysis secondary to a PSVS between the portal vein and left renal vein. Shunt embolism by an 18 mm Amplatzer vascular plug (AVR II) was done and follow up CT showed complete occlusion of collaterals. Post-procedure, he is undergoing thrice-weekly Hemodialysis of 4 hours duration till date with no further incidence of encephalopathy. Our report indicates that recurrent encephalopathy can occur in dialysis patients due to symptomatic PSVS and HRPSE should be considered even in non-cirrhotic cases for early detection and effective management.






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Indian Journal of Nephrology
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