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PRES CNI Toxicity — ESENeph MCQ

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ModerateTransplantationPRES CNI ToxicityESENeph

A kidney transplant recipient on Tacrolimus develops new-onset tremor, headache, and visual disturbance. MRI brain shows posterior white matter oedema bilaterally. Tacrolimus trough is 14 ng/mL. BP is 190/110 mmHg. What is the diagnosis?

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Correct answer: A — CNI-induced posterior reversible encephalopathy syndrome (PRES)

Posterior reversible encephalopathy syndrome (PRES) is characterised by headache, visual disturbance, confusion/seizures, and posterior white matter oedema on MRI. It is associated with CNI toxicity (especially supratherapeutic levels), severe hypertension, and eclampsia. Management involves reducing or stopping the CNI, aggressive BP control, and antiepileptics if seizures occur. The condition is usually reversible with prompt treatment. The MRI findings of bilateral posterior white matter oedema are characteristic.

Reference: Hinchey et al 1996 – PRES; KDIGO 2009 – Transplant