Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Katsuyuki Oi; Tomokazu Okado; Hisako Togo; Soichiro Iimori; Naofumi Yui; Eisei Sohara; Eiichiro Kanda; Tatemitsu Rai; Sei Sasaki; Shinichi Uchida

doi:10.2169/internalmedicine.54.3488

CASE REPORTS

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Katsuyuki Oi, Tomokazu Okado, Hisako Togo, Soichiro Iimori, Naofumi Yui, Eisei Sohara, Eiichiro Kanda, Tatemitsu Rai, Sei Sasaki, Shinichi Uchida

Author information

Katsuyuki Oi
Department of Nephrology, Tokyo Medical and Dental University, Japan
Tomokazu Okado
Department of Nephrology, Tokyo Medical and Dental University, Japan
Hisako Togo
Department of Nephrology, Tokyo Kyosai Hospital, Japan
Soichiro Iimori
Department of Nephrology, Tokyo Medical and Dental University, Japan
Naofumi Yui
Department of Nephrology, Tokyo Medical and Dental University, Japan
Eisei Sohara
Department of Nephrology, Tokyo Medical and Dental University, Japan
Eiichiro Kanda
Department of Nephrology, Tokyo Kyosai Hospital, Japan
Tatemitsu Rai
Department of Nephrology, Tokyo Medical and Dental University, Japan
Sei Sasaki
Department of Nephrology, Tokyo Medical and Dental University, Japan
Shinichi Uchida
Department of Nephrology, Tokyo Medical and Dental University, Japan

Keywords: hepatic encephalopathy (HE), chronic portal-systemic shunt encephalopathy (CPSE), portal-systemic shunt (PSS), hemodialysis

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 11 Pages 1375-1380

DOI https://doi.org/10.2169/internalmedicine.54.3488

Details

Abstract

The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portal-systemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Therefore, it is necessary to recognize CPSE and assess the blood ammonia concentrations in dialysis patients who develop a disturbance of consciousness, even if the serum transaminase level is normal.

Corresponding author

Register with J-STAGE for free!