Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

Background. Non-alcoholic Wernicke’s encephalopathy occurs in various somatic conditions with thiamine deficiency, excessive excretion of thiamine, or impaired thiamine metabolism. Very few cases of this pathology have been described in chronic kidney disease (CKD). We present a unique case of non-alcoholic Wernicke’s encephalopathy in a patient with a kidney transplant is presented.Past medical history. The patient underwent kidney transplantation in 2008. Outpatient follow-up by a nephrologist was irregular. Renal graft function remained relatively stable: blood creatinine 200–240 μmol/L, estimated glomerular filtration rate 40–30 mL/min, tacrolimus plasma concentrations tended to increase (5.7–7.6–8.4–10.4 ng/mL); repeated graft biopsy (in 2015 and in 2017) determined the chronic toxicity of calcineurin inhibitors. The patient’s condition worsened in late January 2020: body temperature increased to 38°C, nausea, vomiting, loose, watery stools for up to 5 times per day, 8 kg weight loss, decreased diuresis. A few days later, double vision, shaky gait and then immobility appeared. Biochemical examination results: potassium 3.8 mmol/L, sodium 139 mmol/L, alpha-amylase 159 units/L (norm 0–100 units/L), creatinine 242 mmol/L, urea 13.2 mmol/L; ultrasound signs of pancreatitis. Magnetic resonance imaging (MRI) of the brain: bilateral diffuse lesions of the midbrain, thalamus, and cerebellum. Based on the clinical picture and on brain MRI results, Wernicke’s encephalopathy was diagnosed. Parenteral administration of thiamine had a good effect.Conclusion. Possible mechanisms of the development of Wernicke’s encephalopathy in a patient were discussed. Vigilance is required regarding this disease when metabolic disorders occur in patients with CKD.

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P1694PROGNOSTIC VALUE OF BODY COMPOSITION ON GRAFT FUNCTIONING IN KIDNEY TRANSPLANT PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1694 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Zorica Dimitrijevic ◽

Branka Mitic ◽

Goran Paunovic ◽

Karolina Paunovic ◽

Danijela Tasic ◽

...

Keyword(s):

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Skinfold Thickness ◽

Cross Sectional Study ◽

Fat Percentage ◽

Cross Sectional ◽

Transplant Patients ◽

Significant Difference ◽

Kidney Transplant Patients

Abstract Background and Aims Post-transplant weight gain and particularly visceral fat gain has been linked to the development of metabolic disorders and cardiovascular disease. Moreover, the effect of obesity on graft function after kidney transplantation has recently become a subject of interest. The aim of our study was to investigate the association of body mass index (BMI), body fat percentage (BF%) and waist-to-hip ratio (WHR) with the kidney function in kidney transplant patients. Method We conducted a cross-sectional study that enrolled 80 kidney transplant patients aged 23–75 years (mean age 46.7 ± 11.5 years, 60% males). Anthropometric measurements of weight, height, waist, and hip circumferences in addition to skinfold thickness were obtained. BH% was calculated using a 4-site skinfold thickness method calculated through the Jackson-Pollock equation with a Harpenden caliper, utilizing a BF% cutoff of 35% for women and 25% for men to define obesity. Results The calculated BMI in our study group was 32.7±8.7 kg/m2, a mean BF% of 29.9±8.5% and a mean WHR of 0.9±0.1 Statistically significant difference in GFR, BMI, WHR and BF% were observed between males and females (r=0.455, p=0.02; r=0.412, p=0.016; r=0.437, p=0.022; r=0.348, p=0.011), respectively. After adjustment for age, gender, donor group, donor age and years of dialysis before transplantation, higher levels of all obesity measures were related to lower eGFR: BMI per 1 SD (β coefficient −3.883, 95% confidence interval [CI] −5,422 to −3,132), WHR (β coefficient −4.443, 95% CI −6.201 to −3.772), and BF% (β coefficient −3.722, 95% CI −4.332 to −3.461). The combination of higher BF% (BF% >33 kg/m2) and central obesity (WHR >0.85 for women, >0.90 for men) was associated with the lowest eGFR compared with that in lean subjects. Conclusion The combination of high BF% and WHR may be an important risk factor for lower GFR in a kidney transplant recipient.

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Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

BMJ Case Reports ◽

10.1136/bcr-2018-227412 ◽

2019 ◽

Vol 12 (1) ◽

pp. e227412 ◽

Cited By ~ 2

Author(s):

Timothy Xin Zhong Tan ◽

Kheng Choon Lim ◽

Charles Chan Chung ◽

Than Aung

Keyword(s):

Thiamine Deficiency ◽

Kidney Injury ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

Good Effect ◽

Diagnostic Dilemma ◽

Sensorimotor Polyneuropathy ◽

Signal Abnormality ◽

Loss Of Weight ◽

Medical Emergencies

A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke’s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke’s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.

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Wernicke’s encephalopathy-induced hearing loss complicating sleeve gastrectomy

BMJ Case Reports ◽

10.1136/bcr-2019-233144 ◽

2020 ◽

Vol 13 (9) ◽

pp. e233144

Author(s):

Elaf Abdulnabi Mohammed ◽

Sulaiman Ali Hajji ◽

Khaled Aljenaee ◽

Mohammad Ibrahim Ghanbar

Keyword(s):

Hearing Loss ◽

Sleeve Gastrectomy ◽

Magnetic Resonance ◽

Brain Mri ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

High Signal ◽

Inversion Recovery Imaging ◽

Successful Recovery ◽

The Brain

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke’s encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67–200).

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Wernicke’s encephalopathy confirmed via brain MRI in cancer patient

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867411427817 ◽

2012 ◽

Vol 46 (1) ◽

pp. 70-71 ◽

Cited By ~ 1

Author(s):

Sang Min Lee ◽

Won Sub Kang ◽

Ah Rang Cho ◽

Jin Kyung Park

Keyword(s):

Cancer Patient ◽

Brain Mri ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy

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Is delayed graft function associated with ureteral stenosis in the kidney transplant recipient? A case-control study

Canadian Urological Association Journal ◽

10.5489/cuaj.5794 ◽

2019 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Axel Cayetano-Alcaraz ◽

Juan Sebastian Rodriguez-Alvarez ◽

Mario Vilatobá-Chapa ◽

Josefina Alberú-Gómez ◽

Bernardo Gabilondo-Pliego ◽

...

Keyword(s):

Risk Factor ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Transplant Patients ◽

Increased Risk ◽

Kidney Transplant Patients ◽

Control Study

Introduction: Ureteral stricture (US) in the kidney transplant recipient is a rare complication that can lead to morbidity and graft loss. Risk factor recognition is crucial in the prevention and management of this entity. Delayed graft function (DGF), as defined by the need for dialysis in the first week after transplantation, has been proposed as a risk factor in previous studies. Our objective is to determine the impact of DGF in US development in kidney transplant patients. Methods: We designed a matched case-control study. US cases in kidney transplant recipients were identified in the 2008–2017 period. We defined US as the rise in serum creatinine associated with findings suggesting obstruction in ultrasound, scintigraphy, or retrograde pyelogram; any other cause of graft dysfunction was excluded. Controls were defined as kidney transplant recipients from the same population and period without US, matched in a 1:2 fashion by age, sex, and donor type. Results: From 532 kidney transplant patients, 31 cases and 62 controls were included. Cumulative US incidence was 58 per 1000 cases. When calculating for odds ratio (OR), post-operative urinoma (OR 3.2; 95% confidence interval [CI] 2.36–4.37) and ureteral duplication (OR 3.29; 95% CI 2.40–4.51) were associated with an increased risk for US, while DGF was not found to be statistically significant as a risk factor (OR 3.3; 95% CI 0.96–11.52). No statistically significant differences were found between groups in other pre- and post-transplant-related factors. Conclusions: DGF was not associated with US in our cohort; however, ureteral duplication and postoperative urinoma were associated with an increased risk of graft ureteral stenosis development.

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Wernicke’s encephalopathy- a case report

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i1.19763 ◽

2018 ◽

Vol 1 (1) ◽

pp. 78-81

Author(s):

Baikuntha Raj Adhikari ◽

N Sapkota ◽

R Gautam ◽

M Basnet ◽

P Koirala ◽

...

Keyword(s):

Alcohol Intake ◽

Acute Onset ◽

Wernicke’S Encephalopathy ◽

Neurological Deficits ◽

Wernicke's Encephalopathy ◽

Confusional State ◽

Mammillary Bodies ◽

Persistent Memory ◽

Magnetic Resonance Imaging Mri ◽

Oculomotor Abnormalities

Wernicke's encephalopathy is a neuropsychiatric disorder characterized by acute onset, nystagmus and oculomotor abnormalities, and a confusional state. Chronic alcohol intake is still the most common reason. Wernicke's encephalopathy, if not recognized and treated, can become irreversible. Common findings in Magnetic Resonance Imaging (MRI) include: symmetric T2 Weighted Image (T2) hyperintensities in peri-aqueductal gray matter, dorsal medial thalamus and mammillary bodies. This case highlights neurological deficits, persistent memory and disorientation.Journal of BP Koirala Institute of Health Sciences, Vol. 1, No. 1, 2018, page: 78-81

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Comparison of norepinephrine and dopamine in kidney transplant recipient on renal graft function

European Journal of Anaesthesiology ◽

10.1097/00003643-201106001-00445 ◽

2011 ◽

Vol 28 ◽

pp. 139-140 ◽

Cited By ~ 1

Author(s):

C. Feng ◽

B. Liu ◽

M. Piao

Keyword(s):

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Graft Function ◽

Renal Graft

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Wernicke’s Encephalopathy: An Unusual Consequence of the Acquired Immune Deficiency Syndrome—Case Report and Literature Review

Case Reports in Medicine ◽

10.1155/2013/709474 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Timothy R. Larsen ◽

Dritan Dragu ◽

Michael Williams

Keyword(s):

Immune Deficiency ◽

Brain Mri ◽

Immune Deficiency Syndrome ◽

Acquired Immune Deficiency Syndrome ◽

Deficiency Syndrome ◽

Wernicke’S Encephalopathy ◽

Wernicke's Encephalopathy ◽

Classic Triad ◽

Relative Safety ◽

Acquired Immune Deficiency

Introduction.Wernicke’s encephalopathy is a well-described syndrome characterized by the classic triad of confusion, ataxia, and ophthalmoplegia. Wernicke’s encephalopathy results from thiamine (vitamin B1) deficiency. Common causes include alcoholism and gastric disorders. Wernicke’s has been described in patients with acquired immune deficiency syndrome (AIDS); however, given these patients’ immunosuppressed state, the diagnosis of Wernicke’s encephalopathy is not apparent.Case Presentation.A 31-year-old previously healthy male presented to the ER complaining of progressive dyspnea. Workup revealed HIV/AIDS and PCP pneumonia. He was treated and improved. On day 14 he became confused and developed nystagmus and ataxia. Considering his immunocompromised state, infectious and neoplastic etiologies topped the differential diagnosis. CT head was negative. Lumbar puncture was unremarkable. Brain MRI revealed increased T2 signal in the medial thalamus bilaterally. Intravenous thiamine was administered resulting in resolution of symptoms.Discussion.The classic triad of Wernicke’s encephalopathy occurs in 10% of cases. When immunosuppressed patients develop acute neurologic symptoms infectious or neoplastic etiologies must be excluded. However, given the relative safety of thiamine supplementation, there should be a low threshold for initiating therapy in order to reverse the symptoms and prevent progression to Korsakoff dementia, which is permanent.

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Concomitant Thrombotic Microangiopathy and Rejection in a Recent Kidney Transplant: A Case Study

10.31487/j.tcr.2020.01.01 ◽

2020 ◽

pp. 1-4

Author(s):

Muhammad A. Bukhari ◽

Abdulaziz Al-Thumali ◽

El-Sadig Yousif ◽

Muhammad A. Bukhari ◽

Najla K Almalki ◽

...

Keyword(s):

Kidney Transplant ◽

Thrombotic Microangiopathy ◽

De Novo ◽

Kidney Transplant Recipient ◽

Calcineurin Inhibitors ◽

Armed Forces ◽

Post Transplantation ◽

Medical Interventions ◽

Antibody Mediated Rejection ◽

Life Threatening

Thrombotic microangiopathy (TMA) is an uncommon, life-threatening complication that adversely affects kidney transplant recipient and allograft survival. Post-transplantation TMA can occur as recurrence of the primary TMA or as a de novo condition. The latter can be triggered by numerous factors post-transplantation including calcineurin inhibitors, certain infections and antibody-mediated rejection. Rejection-associated TMAs carry a significantly lower graft survival rate compared with post-transplant TMAs that are not associated with rejection. In this case report, we present a rare case of rejection-associated TMA in a recently transplanted renal allograft that was managed in Al-Hada Armed Forces Hospital. Despite the poor expected outcome of this condition; the patient was successfully treated after early initiation of medical interventions. Transplantation teams may face many challenges managing such a combination of medical conditions, which may halt pursuing appropriate diagnostic and therapeutic measures in a timely fashion. This article highlights some of these challenges for better understanding of such a complex condition.

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