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-a...
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| Format: | Article |
| Language: | Russian |
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Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov
2021-07-01
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| Series: | Vestnik Transplantologii i Iskusstvennyh Organov |
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| Online Access: | https://journal.transpl.ru/vtio/article/view/1369 |
| _version_ | 1797871909391564800 |
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| author | R. O. Kantariya O. N. Vetchinnikova A. V. Vatazin L. A. Sherman |
| author_facet | R. O. Kantariya O. N. Vetchinnikova A. V. Vatazin L. A. Sherman |
| author_sort | R. O. Kantariya |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T00:51:33Z |
| format | Article |
| id | doaj.art-1196577682384a95854bcf1bf601bd55 |
| institution | Directory Open Access Journal |
| issn | 1995-1191 |
| language | Russian |
| last_indexed | 2024-04-10T00:51:33Z |
| publishDate | 2021-07-01 |
| publisher | Federal Research Center of Transplantology and Artificial Organs named after V.I.Shumakov |
| record_format | Article |
| series | Vestnik Transplantologii i Iskusstvennyh Organov |
| spelling | doaj.art-1196577682384a95854bcf1bf601bd552023-03-13T10:37:27ZrusFederal Research Center of Transplantology and Artificial Organs named after V.I.ShumakovVestnik Transplantologii i Iskusstvennyh Organov1995-11912021-07-01232768310.15825/1995-1191-2021-2-76-83985Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipientR. O. Kantariya0O. N. Vetchinnikova1A. V. Vatazin2L. A. Sherman3Vladimirsky Moscow Regional Research Clinical InstituteVladimirsky Moscow Regional Research Clinical InstituteVladimirsky Moscow Regional Research Clinical InstituteVladimirsky Moscow Regional Research Clinical InstituteBackground. 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.https://journal.transpl.ru/vtio/article/view/1369wernicke’s encephalopathykidney transplantationpancreatitisthiamine |
| spellingShingle | R. O. Kantariya O. N. Vetchinnikova A. V. Vatazin L. A. Sherman Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient Vestnik Transplantologii i Iskusstvennyh Organov wernicke’s encephalopathy kidney transplantation pancreatitis thiamine |
| title | Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient |
| title_full | Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient |
| title_fullStr | Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient |
| title_full_unstemmed | Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient |
| title_short | Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient |
| title_sort | non alcoholic wernicke s encephalopathy in a kidney transplant recipient |
| topic | wernicke’s encephalopathy kidney transplantation pancreatitis thiamine |
| url | https://journal.transpl.ru/vtio/article/view/1369 |
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