Posterior reversible encephalopathy syndrome (PRES) as a complication of immunosuppressive therapy in renal transplantation in children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Posterior Reversible Encephalopathy Syndrome (PRES) as a Complication of Immunosuppressive Therapy in Renal Transplantation in Children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

[The Stevens-Johnson syndrome--personal experience]. / Sindrom Stevens-Johnson--nasa iskustva.

Stevens-Johnson syndrome is a disorder of the skin and mucous membranes and a severe bullous forms include systemic toxic effects. In this study, we have analyzed our experiences according to ages, sex, incidence, ethological irritable factors, differential diagnosis, clinical treatment, in children with Stevens-Johnson syndrome at the Pediatric Clinic in Tuzla. In the period January 1997-May 2002, we treated 14 patients with this syndrome. All patients were male, ages from 11 months to 11.6 years (average 4.5 years). As irritable factors were detected antiepileptics (Phenobarbitol and Tegretol) in 10 children (71.44%), antibiotics (Procain Penicillin and Cephalexin) in 3 children (21.42%), and reason was stayed unknown in 1 child (7.14%). The problem in differential diagnosis usually was toxic epidermal necrolisis (TEN) and graft versus host disease (GvHD). All patients demanded treatment in the pediatric intensive care unit supporting with specialists immunologists, ophthalmologists, dermatologists, infectologists. Treatment included, besides vital volume support, systemic administration of corticosteroids, antibiotics and intensive local therapy lesions of skin and mucous membranes, specially eyes in special sterile conditions. Outcome and results of our medical treatment of all patients were good.