{"paper_id":"3ebe8d59-3be8-4b57-9c8f-c55ced81db78","body_text":"Clinical Characteristics and Outcomes of Children with Hypertensive Encephalopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Characteristics and Outcomes of Children with Hypertensive Encephalopathy Boonsita Wiraboonchai, Chaiyos Khongkhatithum, Norrarat Nimkarn, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6222883/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2025 Read the published version in BMC Pediatrics → Version 1 posted 14 You are reading this latest preprint version Abstract Background Hypertensive encephalopathy (HE) is characterized by a severe increase in blood pressure, leading to neurological symptoms such as severe headache, seizure, and mental status change. The underlying pathophysiology includes a disruption of the cerebral endothelium and blood-brain barrier, leading to cerebral edema and microhemorrhages. Prompt medical treatment is crucial, often leading to full recovery without long-term neurological deficits. However, untreated cases can result in serious complications. This study aimed to describe the clinical characteristics and outcomes of children who developed HE. Materials and Methods A retrospective review of medical records in patients aged < 20 years diagnosed with HE in Ramathibodi Hospital was conducted. Data were collected, including demographics, underlying conditions, clinical presentations, blood pressure levels during HE, medication use, diagnostic investigations, and outcomes. Patients with pre-existing neurological symptoms or incomplete data were excluded. Data between the groups with kidney diseases and non-kidney diseases were compared. Results Fifty-three patients (26 males) were included with a mean age of 8.9 ± 4 years and a median follow-up time of 47.8 months. Kidney disease (51%) was the most common cause of hypertension. Patients with kidney disease were older (10.3 vs. 7.5 years, p = 0.01), had a shorter duration between the diagnosis of underlying conditions and development of HE (70 vs. 457 days, p = 0.04), and a larger proportion of females (66.7% vs. 34.6%, p = 0.02). Neither clinical manifestations such as generalized tonic-clonic seizures, headaches, and mental status changes nor survival were different between the kidney and non-kidney groups. Five patients developed recurrent episodes of HE. The recurrent group had a higher proportion of patients with underlying diseases involving endothelial injuries, such as small vessel vasculitis and calcineurin inhibitors used in post-hematopoietic stem cell transplantation (HSCT) (100% vs. 35.4%, p = 0.009) than the non-recurrent groups. Conclusions Patients with kidney diseases were older and developed HE earlier, but there was no difference in survival between the kidney and non-kidney groups. The group with recurrent episodes of HE was more commonly detected in patients with small vessel vasculitis and calcineurin inhibitors used in post-HSCT, prompting the pediatricians to be vigilant for blood pressure control in these patients. Clinical trial number : not applicable Hypertensive encephalopathy outcomes children characteristics Introduction Hypertensive encephalopathy (HE) is defined by a severe blood pressure elevation resulting in neurological symptoms like severe headaches, nausea, vomiting, alteration of consciousness, and seizures.[ 1 ] In normal circumstances, the brain maintains constant blood flow despite changes in blood pressure, which is called cerebral autoregulation.[ 2 ] However, severe hypertension disrupts the cerebral endothelium and blood-brain barrier, narrowing the vascular lumen by fibrinoid material deposition and inducing vasodilation, leading to cerebral edema and micro-hemorrhages. In this condition, cerebral imaging can vary from normal findings to typical lesions of posterior reversible encephalopathy syndrome (PRES), which is a reversible clinic-radiological syndrome often linked with acute severe hypertension and conditions like eclampsia, sepsis, autoimmune disease, and transplantation[ 3 – 5 ]. Common presentation of HE ranges from headache and mental status change to seizure, with acute post-streptococcal glomerulonephritis and hemato-oncologic diseases being two of the most common causes, followed by those who received hematopoietic stem cell transplantation[ 6 , 7 ]. One study from Korea[ 8 ] compared children with kidney and non-kidney diseases and revealed a higher systolic blood pressure (SBP) at presentation (172.5 mmHg vs. 137.1 mmHg), and a greater incidence of PRES in the kidney group (66.6% vs. 12.5%). A recent study in Thailand[ 7 ] also noted a higher baseline blood pressure in children with kidney diseases who were diagnosed with PRES. While these studies provide valuable insights into HE and PRES, there was still limited data on the characteristics and outcomes of HE in pediatric patients. Therefore, this study aimed to compare the clinical characteristics and outcomes of pediatric HE patients with and without kidney disease and to identify the risk factors associated with recurrent HE episodes. Materials and Methods Study Design This study was conducted retrospectively by reviewing medical records of patients admitted or referred during year 2015–2023 due to HE to Ramathibodi hospital, Bangkok, Thailand. It was approved by the Ethics Committee for Human Research from the Faculty of Medicine Ramathibodi Hospital Mahidol University (MURA 2023/373). HE was defined by patients with hypertension who developed any neurological symptoms such as headache, alteration of consciousness, or seizure. Patients under 20 years old who had experienced at least one HE episode were included but those with incomplete data or pre-existing neurological conditions were excluded. Data Collection Data including four main categories were collected: demographic data, pre-HE data, data during the development of HE, and outcomes. Demographic data included gender, age, and underlying diseases. Pre-HE data included underlying disease, the timing of its diagnosis, and the medications being taken. Data during HE development included clinical presentation, blood pressure, body weight, and height. For comparisons of parameters between different age groups, body mass index was calculated for z-score for age and gender using WHO Anthroplus software and blood pressure was calculated for index by dividing blood pressure with the age-gender specific cut-off for hypertension in each patient (index > 1, meaning that the patient’s blood pressure is above the cut-off for hypertension). Results from various investigations were also obtained, including complete blood count (CBC), creatinine (Cr), and estimated glomerular filtration rate (eGFR) by Schwartz formula[ 9 ]. Furthermore, imaging studies, including computerized tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) results were also collected to provide a comprehensive understanding of neurological involvement during this phase. Finally, outcome data included the number of HE episodes, the duration of anti-seizure medication (ASM) use, and survival rate. Statistical Analysis Data were analyzed using IBM SPSS version 29. The Kolgomorov-Smirnov test was used to test for normality. The T-test or Mann-Whitney test was used to compare continuous data, and the Fisher exact or Chi-square test was used to compare categorical data. Statistical significance was identified when the p- value was less than 0.05. Results Study Population A total of fifty-three (26 male) children with a mean age of 8.96 years were included in the present study after excluding four cases with incomplete data. The patients were divided into two groups based on the causes of hypertension: the kidney group (N = 27) and the non-kidney group (N = 26). In the kidney group, 9 patients had lupus nephritis, while the remaining 18 had other kidney-related conditions. The non-kidney group included 18 patients with hemato-oncologic diseases, including 8 patients who received hematopoietic stem cell transplantation (HSCT). Five patients had gastrointestinal diseases. Two patients with rheumatologic diseases were diagnosed with juvenile idiopathic arthritis and systemic lupus erythematosus without nephritis. There was one healthy child admitted due to respiratory syncytial virus (RSV) bronchitis and received steroid treatment, as shown in Table 1. Table 1 Underlying diseases of the patients in the present study Underlying diseases Number of patients Kidney diseases (N = 27) • Lupus nephritis • Takayasu arteritis with renal artery stenosis • Nephrotic syndrome • Acute post-streptococcal glomerulonephritis • Henoch-SchÖnlein purpura • End-stage kidney disease from unknown cause • Microscopic polyangiitis • Vesicoureteral reflux 9 4 6 1 3 1 1 1 Hematologic/oncologic diseases (N = 18) • Post-HSCT (N = 8) - Transfusion-dependent thalassemia - Hematologic malignancy - Evans syndrome - Hyper-IgM syndrome - Dyskeratosis congenita • Non-HSCT (N = 10) - Hematologic malignancy - Solid tumor - Transfusion-dependent thalassemia - Aplastic anemia 4 1 1 1 1 7 1 1 1 Gastrointestinal diseases (N = 5) • Biliary atresia s/p liver transplantation • Crohn disease 4 1 Rheumatologic diseases (no kidney involvement) 2 A previously healthy child with respiratory syncytial virus bronchitis 1 HSCT, hematopoietic stem cell transplantation Clinical data between the kidney and non-kidney groups Table 2 shows a comparison of parameters between the kidney and non-kidney groups. The patients in the kidney group had a significantly older age (10.33 vs. 7.54 years, p = 0.01) and more females (66.7 vs. 34.6%, p = 0.02) than the non-kidney group. The median duration from the onset of the underlying disease to the development of HE was significantly shorter in the kidney group compared to the non-kidney group (70 vs. 457 days, p = 0.04). The number of anti-hypertensive medications used before developing HE was significantly higher in the kidney group than in the non-kidney group. At the time of HE, the SBP index in the kidney group showed a trend toward higher (1.40 vs 1.29, p = 0.069) compared to the non-kidney group, though this difference did not reach statistical significance. The steroid use before developing HE was comparable in doses between the two groups (5.71 vs. 4.9 mg/kg/day of hydrocortisone, p = 0.889). Generalized tonic-clonic seizure was the most common presentation, with similar proportions between the two groups (81.5 vs 69.2%, p = 0.425). The other symptoms, including headache and focal seizures, except for weakness, were also more frequently observed in the non-kidney group, but these differences were not statistically significant. Table 2 Clinical parameters between the kidney and non-kidney groups Parameters All (N = 53) Kidney (N = 27) Non-Kidney (N = 26) p-value Age (years); mean (SD) 8.96 (4.03) 10.33 (3.77) 7.54 (3.85) 0.010 Gender (male); N (%) 26 (49.1%) 9 (33.3%) 17 (65.4%) 0.020 Duration from underlying condition (days); median (IQR) 130 (18.5-712.5) 70 (14-196) 457 (19.8-1563) 0.040 Z-score of BMI; mean (SD) 0.1 (1.89) -0.14 (1.76) 0.36 (2.02) 0.330 SBP index; mean (SD) 1.35 (0.22) 1.40 (0.23) 1.29 (0.19) 0.069 DBP index; median (IQR) 1.3 (1.2 - 1.5) 1.3 (1.2 - 1.5) 1.2 (1.1 - 1.5) 0.215 Number of anti-hypertensive medications*; median (IQR) 1(0-3) 3 (1-3) 0 (0-1) 0.001 Steroid use; N (%) 43 (81.1%) 22 (81.5%) 21 (80.8%) 0.947 Dose of steroid* (mg/kg of hydrocortisone); median (IQR) 4.62 (1.16-8) 5.71 (0 - 8) 4.9 (1.2- 8.3) 0.889 Clinical manifestations - Generalized tonic-clonic seizure 40 (75.5%) 22 (81.5%) 18 (69.2%) 0.425 - Alteration of consciousness 7 (13.2%) 3 (11.1%) 4 (15.4%) - Headache 3 (5.7%) 1 (3.7%) 2 (7.7%) - Focal seizure 2 (3.8%) 0 (0%) 2 (7.7%) - Weakness 1 (1.9%) 1 (3.7%) 0 (0%) Hemoglobin (g/dL); mean (SD) 11.30 (1.79) 11.17 (1.70) 11.44 (1.90) 0.593 White blood cell (/cumm); mean (SD) 10,779.57 (8,438.71) 14,472.22 (7574.09) 6944.88 (7644.57) <0.001 Platelet (x 1000/cumm); median (IQR) 181 (73 - 337) 298 (134 - 408) 102 (37.25 - 188.25) 0.004 eGFR; mean (SD) 119.09 (76.43) 81.98 (61.54) 157.64 (71.96) <0.001 CT; yes, n (%) 44 (83.02%) 19 (70.37%) 25 (96.15%) 0.024 MRI; yes, n (%) 30 (56.6%) 13 (48.15%) 17 (65.38%) 0.206 EEG; yes, n (%) 28 (52.83%) 17 (62.96%) 11 (42.31%) 0.132 Abnormal imaging (CT/MRI); N (%) 41 (77.36%) 21 (77.78%) 20 (76.92%) 0.941 - Typical PRES 36/41 (88%) 19/21 (90%) 17/20 (85%) 0.697 Abnormal EEG; N (%) 16 (30.19%) 10 (37.04%) 6 (23.08%) 1.000 Anti-seizure medication (ASM) - No ASM 10 (18.87%) 5 (18.52%) 5 (19.23%) 0.054 - Levetiracetam 23 (43.40%) 8 (29.63%) 15 (57.69%) - Phenytoin 13 (24.53%) 10 (37.04%) 3 (11.54%) - Sodium valproate 3 (5.66%) 3 (11.11%) 0 (0%) - Phenobarbital 2 (3.77%) 1 (3.70%) 1 (3.85%) - Topiramate 2 (3.77%) 0 (0%) 2 (7.69%) Duration of anti-seizure medication (days); median (IQR) 75 (12-373) 113 (7-373) 63.5 (18-393.75) 0.569 Number of recurrent episodes; median (IQR) 1 (1-1) 1 (1-1) 1 (1-1) 0.965 Duration of follow-up (months); mean (SD) 49.77 (44.49) 56.78 (46.99) 42.50 (41.38) 0.247 Survival at last follow-up; N (%) 44 (83%) 24 (88.9%) 20 (76.9%) 0.293 SD, standard deviation; IQR, inter-quartile range; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; CT, computerized tomography; MRI, magnetic resonance imaging; PRES, posterior reversible encephalopathy syndrome; CNS, central nervous system; EEG, electroencephalography Laboratory data Laboratory findings revealed that the number of white blood cells and platelets were significantly higher in the kidney group than the non-kidney group (14,472 vs. 6,944.88/cumm, p < 0.001 and 298,000 vs. 102,000/cumm, p = 0.004, respectively) but comparable hemoglobin levels between the two groups were observed. The kidney group had a significantly lower eGFR than the non-kidney group (81.98 vs 157.64 mL/min/1.73m 2 , p < 0.001). Imaging and electroencephalogram Imaging and EEG findings were also assessed. Fourty-four (83.02%) and thirty patients (56.6%) underwent brain CT and MRI, respectively. Overall, abnormal imaging results (CT or MRI) were seen in comparable proportions between the two groups (77.78 vs 76.92%). Typical PRES was the most common neuroimaging abnormality, occurring 90% in the kidney group and 85% in the non-kidney group ( p = 0.697). EEG was assessed in 28 patients (52.83%), with abnormal EEG results less commonly observed in 30.19%, but no significant difference between the two groups. Outcomes Only 10 patients with HE (18.87%) did not need anti-seizure medication (ASM), while the rest were on ASM, with 43.4% receiving levetiracetam as the most common ASM for seizure control. Phenytoin, sodium valproate, phenobarbital, and topiramate were used in smaller proportions between the two groups. The median duration of ASM was no significant difference between the two groups (113 vs. 63 days, p = 0.569). The overall survival rate was high (83%), with no significant differences between the two groups. Among the nine patients who expired during follow-up, three were from the kidney group, and six were from the non-kidney group. The causes of death were sepsis, except for one patient in the kidney group, who experienced fatal cerebral hemorrhage and brain herniation following the fourth episode of HE, and one patient in the non-kidney group, who expired after receiving palliative care. Follow-up imaging was performed only in 16 patients, with 8 from each group. In the kidney group, 4 patients had normal imaging, while 2 patients showed complete resolution of PRES, and the remaining 2 patients showed only partial resolution of PRES, with no progression of the abnormalities or lesions in this group. In the non-kidney group, 1 patient had a progression of PRES, and another 1 patient showed permanent damage from PRES. Follow-up EEG was also performed in 11 patients, with 5 from the kidney and 6 from the non-kidney groups. Most patients showed normal EEG results, except one from the non-kidney group whose EEG showed intermittent focal slow, suggesting mild cerebral dysfunction. Recurrent episode of HE Table 3 describes the characteristics of 5 patients with recurrent episodes of HE. Comparing the recurrent and non-recurrent HE groups (Table 4), there was no significant difference in age, duration of ASM, and survival between the two groups. Nonetheless, imaging findings indicated that the recurrent HE group exhibited a higher number of CT lesions in the first HE episode (2.5 vs 1, p = 0.115) compared to the non-recurrent group, though it was still not significantly different. For blood pressure indices, while not significantly different between the two groups, there was a trend toward lower SBP and DBP indices in the recurrent group. Interestingly, the proportion of patients with small vessel vasculitis (lupus nephritis and microscopic polyangiitis) and calcineurin inhibitors used in post-HSCT was significantly more common in the recurrent than the non-recurrent groups. Table 3 Characteristics of 5 patients with recurrent hypertensive encephalopathy Gender Underlying diseases Post-HSCT Small vessel vasculitis Age (years) Imaging Episodes Female Beta thalassemia major ✓ 14 PRES 3 Female End-stage kidney disease from microscopic polyangiitis ✓ 11 PRES 4 Female SLE with LN ✓ 9 PRES 2 Male SLE with LN ✓ 14 PRES 2 Male Dyskeratosis congenita ✓ 11 Atypical PRES 2 HSCT, hematopoietic stem cell transplantation; SLE, systemic lupus erythematosus; LN, lupus nephritis; PRES, posterior reversible encephalopathy syndrome Table 4 Clinical parameters at the first episode between the recurrent and non-recurrent groups Parameters Non-recurrent (N = 48) Recurrent (N = 5) p-value Age (years), mean (SD) 9.19 (4.13) 11.8 (2.17) 0.157 Small vessel vasculitis or CNI used in post-HSCT; N (%) 17 (35.42%) 5 (100%) 0.009 Kidney diseases; N (%) 24 (50%) 3 (60%) 0.670 SBP index, mean (SD) 1.36 (0.22) 1.22 (0.15) 0.152 DBP index, mean (SD) 1.40 (0.33) 1.18 (0.14) 0.120 Numbers of CT lesions, median (IQR) 1 (0-2) 2.5 (2-3.75) 0.115 Duration of ASM, median (IQR) 63.5 (13-293) 372 (187-293) 0.889 Duration of follow-up (months); mean (SD) 51.04 (43.81) 37.6 (54.52) 0.525 Survival at last follow-up; N (%) 41 (85.4%) 3 (60%) 0.196 SD, standard deviation; IQR, inter-quartile range; HSCT, hematopoietic stem cell transplantation; SBP, systolic blood pressure; DBP, diastolic blood pressure; CT, computerized tomography; ASM, anti-seizure medications Discussion The present study highlights insights into the clinical characteristics and outcomes of pediatric HE. The kidney group experienced HE at an older age, was predominantly female, developed an episode of HE earlier, and required a higher number of anti-hypertensive medications than the non-kidney group. Almost 10% of patients developed recurrent episodes of HE, and this was seen as more common in patients with small vessel vasculitis or post-HSCT. There are limited data on the clinical outcomes of children with HE. Most of the previous studies were retrospectively conducted in a single center. In the present study, most patients in the kidney group were older females with lupus nephritis compared to the non-kidney group, which is consistent with the previous study in Thailand.[ 7 ] However, another study in Korea[ 8 ] revealed that the kidney group had a younger age. This discrepancy may be attributed to differences in the causes of hypertension between the studies. In the latter study, the common cause of hypertension in the kidney group was renal artery stenosis, with a lesser proportion being lupus nephritis. In addition, the present study revealed that the kidney group developed HE earlier after diagnosis of the underlying diseases and required a higher number of anti-hypertensive medications than those in the non-kidney group. At the first HE episode, the kidney group showed a trend toward higher systolic blood pressure than the non-kidney group. These findings were also observed in the previous studies[ 7 , 10 ]. Altogether, these findings emphasize the importance of monitoring and early intervention in pediatric patients, especially those with kidney diseases, to prevent HE. Seizure was the most common presentation in the present study, with generalized tonic-clonic being the most common semiology occurring in 75% of patients. The previous studies also reported that 65–93% of patients presented with generalized tonic-clonic seizures.[ 8 , 10 – 12 ] The non-kidney group in the present study showed lower white blood cell and platelet numbers than the kidney group. This could be explained by the fact that most patients in the non-kidney group had hematologic or oncologic diseases. Brain imaging was performed in nearly all patients, but only half had an EEG study. Abnormalities detected from the neuroimaging or EEG were not significantly different between the kidney and non-kidney groups, which was consistent with the previous study [ 7 ]. Another study by Ahn et al reported that all 9 patients in the kidney group had abnormal MRI findings and 6 had typical PRES lesions, but only 5 out of 8 non-kidney patients had abnormal MRI [ 8 ]. The present study revealed that nearly 10% of patients had recurrent HE episodes, but the proportion of patients with kidney diseases was comparable between the recurrent and non-recurrent groups. Another study[ 7 ] reported that 25% (4 out of 16) of patients had recurrent HE episodes, and all 4 patients had kidney diseases. The present study observed that about 23% (5 out of 22) of patients with small vessel vasculitis or those who received HSCT had recurrent HE episodes. As the pathogenesis of HE is related to the disruption of endothelial cells commonly found in patients with small vessel vasculitis or post-HSCT being on calcineurin inhibitors, we postulated that this may explain why these two conditions share a common risk of recurrent HE episodes. Though not statistically significant, patients with recurrent HE episodes required a longer duration of ASM use and exhibited a lower survival rate, highlighting the poor prognosis associated with recurrent HE. The kidney and non-kidney groups had similar rates of abnormal CT and MRI findings during HE episodes. However, between the non-recurrent and recurrent HE groups, those with recurrent HE episodes had more CT lesions, suggesting that recurrent episodes may cause further brain damage. The present study described the clinical characteristics and outcomes of pediatric patients with HE with a larger number than reported in the previous studies[ 6 – 8 ]. We also noted a group of patients with recurrent HE episodes, particularly in patients with small vessel vasculitis or post-HSCT. However, the present study had some limitations. Firstly, only a small proportion of patients with follow-up imaging and EEGs. Secondly, the doses of steroids and other medications that might be related to the development of hypertension were not thoroughly reviewed. Thirdly, the number of patients with recurrent HE episodes was small, multivariate analysis for the recurrence risk was not applicable for the present study. In conclusion, the present study provides valuable information about the characteristics and outcomes of pediatric HE. Key findings include (1) patients with kidney diseases were older and developed HE at an earlier age compared to those without kidney diseases; (2) No difference in clinical manifestations, duration of ASM, and survival was detected between the kidney and non-kidney groups; (3) The recurrent HE group had a higher proportion of patients with small vessel vasculitis or post-HSCT. These findings highlight the importance of early recognition, blood pressure management, and targeted interventions for high-risk pediatric populations. In addition, patients with either small vessel vasculitis or calcineurin inhibitor used in post-HSCT who have developed an episode of HE should be carefully monitored for blood pressure as they are at risk of recurrent episodes of HE. Abbreviations HE, hypertensive encephalopathy; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; CT, computerized tomography; MRI, magnetic resonance imaging; PRES, posterior reversible encephalopathy syndrome; CNS, central nervous system; EEG, electroencephalography; HSCT, hematopoietic stem cell transplantation; SLE, systemic lupus erythematosus; LN, lupus nephritis; PRES, posterior reversible encephalopathy syndrome Declarations Ethics approval and consent to participate The present study was approved, and informed consent was waived by the Ethics Committee for Human Research, Faculty of Medicine Ramathibodi Hospital, Mahidol University (MURA 2023/373) due to the retrospective design of the present study. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Completing interests The authors declare no conflict of interest relevant to this study. Funding Not applicable. Authors’ contributions BW, CK, NN, SC, PS, KT and KP had substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; BW, CK and KP had significant contributions to drafting the article and revising it critically for important intellectual content; BW, CK, NN, SC, PS, KT and KP had approved the manuscript of the version to be published. Acknowledgements The authors are grateful to the Department of Pediatrics at Ramathibodi Hospital Mahidol University. References Raina R, Mahajan Z, Sharma A, Chakraborty R, Mahajan S, Sethi SK, Kapur G, Kaelber D: Hypertensive Crisis in Pediatric Patients: An Overview . Frontiers in Pediatrics 2020, 8 . Seeman T, Hamdani G, Mitsnefes M: Hypertensive crisis in children and adolescents . Pediatr Nephrol 2019, 34 (12):2523-2537. Sharma S, Tiwari S, Yadav T, Saini L, Mittal A, Khera D, Garg PK, Khera PS: Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation . Pediatr Radiol 2024, 54 (11):1884-1895. Halbach SM, Stein D: Posterior Reversible Encephalopathy Syndrome in Children and Adolescents . Curr Hypertens Rep 2024, 26 (8):349-354. Hilal K, Khandwala K, Sajjad N, Kaleemi R, Malik AA, Mohsin S, Ibrahim SH: Paediatric posterior reversible encephalopathy syndrome: is there an association of blood pressure with imaging severity and atypical magnetic resonance characteristics? Pediatr Radiol 2022, 52 (13):2610-2619. Aygünes U, Sasmaz HI, Arpacı T, Akbaş T, Özcan N, Antmen AB: Clinical and Radiological Characteristics of Classical and Variant Type of Posterior Reversible Encephalopathy Syndrome on Prognosis Following Hematopoietic Stem Cell Transplantation in Pediatric Patients: A Single-Center Experience . Exp Clin Transplant 2024, 22 (10):800-809. Virojtriratana T, Hongsawong N, Wiwattanadittakul N, Katanyuwong K, Chartapisak W, Sanguansermsri C: Comparison of Clinical Manifestations, Laboratory, Neuroimaging Findings, and Outcomes in Children With Posterior Reversible Encephalopathy Syndrome (PRES) in Children With and Without Renal Disease . Pediatr Neurol 2022, 134 :37-44. Ahn CH, Han SA, Kong YH, Kim SJ: Clinical characteristics of hypertensive encephalopathy in pediatric patients . Korean J Pediatr 2017, 60 (8):266-271. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL: New equations to estimate GFR in children with CKD . J Am Soc Nephrol 2009, 20 (3):629-637. Ajmi H, Brahim J, Mabrouk S, Ben Abdallah A, Zouari N, Majdoub F, Nouir S, Hasni I, Ben Cheikh Y, Chemli J et al : Clinical and radiological findings of posterior reversible encephalopathy syndrome in children: About 16 children hospitalized in the pediatric department of a Tunisian tertiary care hospital . Eur J Paediatr Neurol 2023, 43 :18-26. Gün E, Akova B, Botan E, Çelik DB, Balaban B, Özen H, Gencay AG, Bektaş Ö, Fitoz S, Kendirli T: Clinical features and outcomes of children admitted to the pediatric intensive care unit due to posterior reversible encephalopathy syndrome . Clin Neurol Neurosurg 2022, 222 :107476. Ba H, Peng H, Xu L, Qin Y, Wang H: Clinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis-A Retrospective, Single-Center Study in China . Front Cardiovasc Med 2022, 9 :891804. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Jul, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 07 Apr, 2025 Reviews received at journal 01 Apr, 2025 Reviews received at journal 30 Mar, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviews received at journal 27 Mar, 2025 Reviewers agreed at journal 27 Mar, 2025 Reviewers agreed at journal 27 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviewers agreed at journal 25 Mar, 2025 Reviewers invited by journal 25 Mar, 2025 Editor assigned by journal 24 Mar, 2025 Editor invited by journal 24 Mar, 2025 Submission checks completed at journal 21 Mar, 2025 First submitted to journal 21 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6222883\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":436818788,\"identity\":\"aa6f7992-f446-4978-aaf6-af17b4332f1b\",\"order_by\":0,\"name\":\"Boonsita Wiraboonchai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mahidol University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Boonsita\",\"middleName\":\"\",\"lastName\":\"Wiraboonchai\",\"suffix\":\"\"},{\"id\":436818789,\"identity\":\"fed29ae3-d23e-4a2c-9c6b-9e50ae3aa7e8\",\"order_by\":1,\"name\":\"Chaiyos 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Saisawat\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mahidol University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Pawaree\",\"middleName\":\"\",\"lastName\":\"Saisawat\",\"suffix\":\"\"},{\"id\":436818804,\"identity\":\"577f75eb-db63-458d-ade8-e2cc697c1354\",\"order_by\":5,\"name\":\"Kanchana Tangnararatchakit\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Mahidol University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kanchana\",\"middleName\":\"\",\"lastName\":\"Tangnararatchakit\",\"suffix\":\"\"},{\"id\":436818808,\"identity\":\"342961d3-de48-4e4b-8633-39c617091652\",\"order_by\":6,\"name\":\"Kwanchai Pirojsakul\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYPCCA3Jg8gHxOhIOGIO1JJCiJbEBTBOj2Fwi/fJr3h930ueHHX4ItMVOTreBgBbLGTll1jwJz3I33k4zAGpJNjY7QECLwY2cNGOehMO5G2cngLQcSNxGrJZ0w9npH4jVkn74MVBLgrx0DpG2WPa8YWOck3bYcIN0TsGBBAMi/GLOnv74wxubw/Lys9M3f/hQYSdH2PsMPGZSPCDGAQiXMDBgYH/88QeQId9AhOpRMApGwSgYmQAA3qBMwWxwAooAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Mahidol University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Kwanchai\",\"middleName\":\"\",\"lastName\":\"Pirojsakul\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-03-14 00:23:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6222883/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6222883/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12887-025-05909-w\",\"type\":\"published\",\"date\":\"2025-07-17T16:05:37+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":88506118,\"identity\":\"c245746c-cffc-4e39-be87-6190352d6e5c\",\"added_by\":\"auto\",\"created_at\":\"2025-08-07 07:31:20\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1460276,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6222883/v1/fe09a50c-403b-483b-9f63-f3b68d781359.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Clinical Characteristics and Outcomes of Children with Hypertensive Encephalopathy\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eHypertensive encephalopathy (HE) is defined by a severe blood pressure elevation resulting in neurological symptoms like severe headaches, nausea, vomiting, alteration of consciousness, and seizures.[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] In normal circumstances, the brain maintains constant blood flow despite changes in blood pressure, which is called cerebral autoregulation.[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e] However, severe hypertension disrupts the cerebral endothelium and blood-brain barrier, narrowing the vascular lumen by fibrinoid material deposition and inducing vasodilation, leading to cerebral edema and micro-hemorrhages. In this condition, cerebral imaging can vary from normal findings to typical lesions of posterior reversible encephalopathy syndrome (PRES), which is a reversible clinic-radiological syndrome often linked with acute severe hypertension and conditions like eclampsia, sepsis, autoimmune disease, and transplantation[\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eCommon presentation of HE ranges from headache and mental status change to seizure, with acute post-streptococcal glomerulonephritis and hemato-oncologic diseases being two of the most common causes, followed by those who received hematopoietic stem cell transplantation[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. One study from Korea[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] compared children with kidney and non-kidney diseases and revealed a higher systolic blood pressure (SBP) at presentation (172.5 mmHg vs. 137.1 mmHg), and a greater incidence of PRES in the kidney group (66.6% vs. 12.5%). A recent study in Thailand[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] also noted a higher baseline blood pressure in children with kidney diseases who were diagnosed with PRES.\\u003c/p\\u003e \\u003cp\\u003eWhile these studies provide valuable insights into HE and PRES, there was still limited data on the characteristics and outcomes of HE in pediatric patients. Therefore, this study aimed to compare the clinical characteristics and outcomes of pediatric HE patients with and without kidney disease and to identify the risk factors associated with recurrent HE episodes.\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Design\\u003c/h2\\u003e \\u003cp\\u003eThis study was conducted retrospectively by reviewing medical records of patients admitted or referred during year 2015\\u0026ndash;2023 due to HE to Ramathibodi hospital, Bangkok, Thailand. It was approved by the Ethics Committee for Human Research from the Faculty of Medicine Ramathibodi Hospital Mahidol University (MURA 2023/373). HE was defined by patients with hypertension who developed any neurological symptoms such as headache, alteration of consciousness, or seizure. Patients under 20 years old who had experienced at least one HE episode were included but those with incomplete data or pre-existing neurological conditions were excluded.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eData Collection\\u003c/h3\\u003e\\n\\u003cp\\u003eData including four main categories were collected: demographic data, pre-HE data, data during the development of HE, and outcomes. Demographic data included gender, age, and underlying diseases. Pre-HE data included underlying disease, the timing of its diagnosis, and the medications being taken. Data during HE development included clinical presentation, blood pressure, body weight, and height. For comparisons of parameters between different age groups, body mass index was calculated for z-score for age and gender using WHO Anthroplus software and blood pressure was calculated for index by dividing blood pressure with the age-gender specific cut-off for hypertension in each patient (index\\u0026thinsp;\\u0026gt;\\u0026thinsp;1, meaning that the patient\\u0026rsquo;s blood pressure is above the cut-off for hypertension). Results from various investigations were also obtained, including complete blood count (CBC), creatinine (Cr), and estimated glomerular filtration rate (eGFR) by Schwartz formula[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Furthermore, imaging studies, including computerized tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) results were also collected to provide a comprehensive understanding of neurological involvement during this phase.\\u003c/p\\u003e \\u003cp\\u003eFinally, outcome data included the number of HE episodes, the duration of anti-seizure medication (ASM) use, and survival rate.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eData were analyzed using IBM SPSS version 29. The Kolgomorov-Smirnov test was used to test for normality. The T-test or Mann-Whitney test was used to compare continuous data, and the Fisher exact or Chi-square test was used to compare categorical data. Statistical significance was identified when the \\u003cem\\u003ep-\\u003c/em\\u003evalue was less than 0.05.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy Population\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of fifty-three (26 male) children with a mean age of 8.96 years were included in the present study after excluding four cases with incomplete data. The patients were divided into two groups based on the causes of hypertension: the kidney group (N = 27) and the non-kidney group (N = 26).\\u0026nbsp;In the kidney group, 9 patients had lupus nephritis, while the remaining 18 had other kidney-related conditions. The non-kidney group included 18 patients with hemato-oncologic diseases, including 8 patients who received hematopoietic stem cell transplantation (HSCT). Five patients had gastrointestinal diseases. Two patients with rheumatologic diseases were diagnosed with juvenile idiopathic arthritis and systemic lupus erythematosus without nephritis. There was one healthy child admitted due to respiratory syncytial virus (RSV) bronchitis and received steroid treatment, as shown in Table 1.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e Underlying diseases of the patients in the present study\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eUnderlying diseases\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber of patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003eKidney diseases (N = 27)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Lupus nephritis\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Takayasu arteritis with renal artery stenosis\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Nephrotic syndrome\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Acute post-streptococcal glomerulonephritis\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Henoch-Sch\\u0026Ouml;nlein purpura\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; End-stage kidney disease from unknown cause\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Microscopic polyangiitis\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Vesicoureteral reflux\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003eHematologic/oncologic diseases (N = 18)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Post-HSCT (N = 8)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp;- Transfusion-dependent thalassemia\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Hematologic malignancy\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Evans syndrome\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Hyper-IgM syndrome\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Dyskeratosis congenita\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Non-HSCT (N = 10)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Hematologic malignancy\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Solid tumor\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Transfusion-dependent thalassemia\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; - Aplastic anemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003eGastrointestinal diseases (N = 5)\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Biliary atresia s/p liver transplantation\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026bull; Crohn disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003eRheumatologic diseases (no kidney involvement)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 420px;\\\"\\u003e\\n \\u003cp\\u003eA previously healthy child with respiratory syncytial virus bronchitis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 204px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eHSCT, hematopoietic stem cell transplantation\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical data between the kidney and non-kidney groups\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 2 shows a comparison of parameters between the kidney and non-kidney groups. The patients in the kidney group had a significantly older age (10.33 vs. 7.54 years,\\u003cem\\u003e\\u0026nbsp;p\\u003c/em\\u003e = 0.01) and more females (66.7 vs. 34.6%, \\u003cem\\u003ep\\u0026nbsp;\\u003c/em\\u003e= 0.02) than the non-kidney group. The median duration from the onset of the underlying disease to the development of HE was significantly shorter in the kidney group compared to the non-kidney group (70 vs. 457 days, \\u003cem\\u003ep\\u003c/em\\u003e = 0.04). The number of anti-hypertensive medications used before developing\\u0026nbsp;HE\\u0026nbsp;was significantly higher in the kidney group than in the non-kidney group. At the time of\\u0026nbsp;HE, the SBP index in the kidney group showed a trend toward higher (1.40 vs 1.29, \\u003cem\\u003ep\\u003c/em\\u003e = 0.069) compared to the non-kidney group, though this difference did not reach statistical significance. The steroid use before developing HE was comparable in doses between the two groups (5.71 vs. 4.9 mg/kg/day of hydrocortisone, \\u003cem\\u003ep\\u003c/em\\u003e = 0.889). Generalized tonic-clonic seizure was the most common presentation, with similar proportions between the two groups (81.5 vs 69.2%, \\u003cem\\u003ep\\u003c/em\\u003e = 0.425). The other symptoms, including headache and focal seizures, except for weakness, were also more frequently observed in the non-kidney group, but these differences were not statistically significant.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2\\u0026nbsp;\\u003c/strong\\u003eClinical parameters between the kidney and non-kidney groups\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameters\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAll\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 53)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eKidney\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 27)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-Kidney\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 26)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eAge (years); mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e8.96 (4.03)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e10.33 (3.77)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e7.54 (3.85)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.010\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eGender (male); N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e26 (49.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e9 (33.3%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e17 (65.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eDuration from underlying condition (days); median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e130\\u003c/p\\u003e\\n \\u003cp\\u003e(18.5-712.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e70\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(14-196)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e457\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(19.8-1563)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.040\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eZ-score of BMI; mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0.1 (1.89)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e-0.14 (1.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0.36 (2.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.330\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eSBP index; mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.35 (0.22)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1.40 (0.23)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.29 (0.19)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.069\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eDBP index; median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.3 (1.2 - 1.5)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1.3 (1.2 - 1.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1.2 (1.1 - 1.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.215\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eNumber of anti-hypertensive medications*; median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1(0-3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e3 (1-3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0 (0-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eSteroid use; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e43 (81.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e22 (81.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e21 (80.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.947\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eDose of steroid* (mg/kg of hydrocortisone); median (IQR)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e4.62 (1.16-8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e5.71 (0 - 8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e4.9 (1.2- 8.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.889\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\" valign=\\\"top\\\" style=\\\"width: 623px;\\\"\\u003e\\n \\u003cp\\u003eClinical manifestations\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Generalized tonic-clonic seizure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e40 (75.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e22 (81.5%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e18 (69.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"5\\\" valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.425\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Alteration of consciousness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e7 (13.2%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e3 (11.1%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e4 (15.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Headache\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e3 (5.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (7.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Focal seizure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (3.8%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (7.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Weakness\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1 (1.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.7%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eHemoglobin (g/dL); mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e11.30 (1.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e11.17 (1.70)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e11.44 (1.90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.593\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eWhite blood cell (/cumm); mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10,779.57 (8,438.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e14,472.22 (7574.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e6944.88 (7644.57)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003ePlatelet (x 1000/cumm); median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e181\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(73 - 337)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e298\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(134 - 408)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e102\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(37.25 - 188.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.004\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eeGFR; mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e119.09 (76.43)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e81.98 (61.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e157.64 (71.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eCT; yes, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e44 (83.02%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e19 (70.37%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e25 (96.15%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eMRI; yes, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e30 (56.6%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e13 (48.15%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e17 (65.38%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.206\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eEEG; yes, n (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e28 (52.83%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e17 (62.96%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e11 (42.31%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.132\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eAbnormal imaging (CT/MRI); N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e41 (77.36%)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e21 (77.78%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e20 (76.92%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.941\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- Typical PRES\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e36/41 (88%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e19/21 (90%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e17/20 (85%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.697\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eAbnormal EEG; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e16 (30.19%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e10 (37.04%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e6 (23.08%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e1.000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"5\\\" valign=\\\"top\\\" style=\\\"width: 623px;\\\"\\u003e\\n \\u003cp\\u003eAnti-seizure medication (ASM)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; No ASM\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e10 (18.87%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e5 (18.52%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e5 (19.23%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd rowspan=\\\"6\\\" valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.054\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; Levetiracetam\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e23 (43.40%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e8 (29.63%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e15 (57.69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; Phenytoin\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e13 (24.53%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e10 (37.04%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e3 (11.54%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; Sodium valproate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e3 (5.66%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e3 (11.11%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; Phenobarbital\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (3.77%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.70%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1 (3.85%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003e- \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Topiramate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (3.77%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e0 (0%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e2 (7.69%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eDuration of anti-seizure medication (days); median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e75\\u003c/p\\u003e\\n \\u003cp\\u003e(12-373)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e113\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(7-373)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e63.5\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e(18-393.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.569\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eNumber of recurrent episodes; median (IQR)\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1 (1-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e1 (1-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e1 (1-1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.965\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eDuration of follow-up (months); mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e49.77 (44.49)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e56.78 (46.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e42.50 (41.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.247\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 256px;\\\"\\u003e\\n \\u003cp\\u003eSurvival at last follow-up; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e44 (83%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 98px;\\\"\\u003e\\n \\u003cp\\u003e24 (88.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 102px;\\\"\\u003e\\n \\u003cp\\u003e20 (76.9%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 65px;\\\"\\u003e\\n \\u003cp\\u003e0.293\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eSD, standard deviation; IQR, inter-quartile range; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; CT, computerized tomography; MRI, magnetic resonance imaging; PRES, posterior reversible encephalopathy syndrome; CNS, central nervous system; EEG, electroencephalography\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eLaboratory data\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eLaboratory findings revealed that the number of white blood cells and platelets were significantly higher in the kidney group than the non-kidney group (14,472 vs. 6,944.88/cumm, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001 and 298,000 vs. 102,000/cumm, \\u003cem\\u003ep\\u003c/em\\u003e = 0.004, respectively) but comparable hemoglobin levels between the two groups were observed. The kidney group had a significantly lower eGFR than the non-kidney group (81.98 vs 157.64 mL/min/1.73m\\u003csup\\u003e2\\u003c/sup\\u003e, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eImaging and electroencephalogram\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eImaging and EEG findings were also assessed. Fourty-four (83.02%) and thirty patients (56.6%) underwent brain CT and MRI, respectively. Overall, abnormal imaging results (CT or MRI) were seen in comparable proportions between the two groups (77.78 vs 76.92%). Typical PRES was the most common neuroimaging abnormality, occurring 90% in the kidney group and 85% in the non-kidney group (\\u003cem\\u003ep\\u003c/em\\u003e= 0.697). EEG was assessed in 28 patients (52.83%), with abnormal EEG results less commonly observed in 30.19%, but no significant difference between the two groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOutcomes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOnly 10 patients with\\u0026nbsp;HE\\u0026nbsp;(18.87%) did not need anti-seizure medication (ASM), while the rest were on ASM, with 43.4% receiving levetiracetam as the most common ASM for seizure control. Phenytoin, sodium valproate, phenobarbital, and topiramate were used in smaller proportions between the two groups. The median duration of ASM was no significant difference between the two groups (113 vs. 63 days, \\u003cem\\u003ep\\u003c/em\\u003e = 0.569). The overall survival rate was high (83%), with no significant differences between the two groups. Among the nine patients who expired during follow-up, three were from the kidney group, and six were from the non-kidney group. The causes of death were sepsis, except for one patient in the kidney group, who experienced fatal cerebral hemorrhage and brain herniation following the fourth episode of HE, and one patient in the non-kidney group, who expired after receiving palliative care.\\u003c/p\\u003e\\n\\u003cp\\u003eFollow-up imaging was performed only in 16 patients, with 8 from each group. In the kidney group, 4 patients had normal imaging, while 2 patients showed complete resolution of PRES, and the remaining 2 patients showed only partial resolution of PRES, with no progression of the abnormalities or lesions in this group. In the non-kidney group, 1 patient had a progression of PRES, and another 1 patient showed permanent damage from PRES. Follow-up EEG was also performed in 11 patients, with 5 from the kidney and 6 from the non-kidney groups. Most patients showed normal EEG results, except one from the non-kidney group whose EEG showed intermittent focal slow, suggesting mild cerebral dysfunction.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRecurrent episode of HE\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTable 3 describes the characteristics of 5 patients with recurrent episodes of HE. Comparing the recurrent and non-recurrent HE groups (Table 4), there was no significant difference in age, duration of ASM, and survival between the two groups. Nonetheless, imaging findings indicated that the recurrent HE group exhibited a higher number of CT lesions in the first HE episode (2.5 vs 1, p = 0.115) compared to the non-recurrent group, though it was still not significantly different. For blood pressure indices, while not significantly different between the two groups, there was a trend toward lower SBP and DBP indices in the recurrent group. Interestingly, the proportion of patients with small vessel vasculitis\\u0026nbsp;(lupus nephritis and microscopic polyangiitis) and calcineurin inhibitors used in\\u0026nbsp;post-HSCT was significantly more common in the recurrent than the non-recurrent groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3\\u0026nbsp;\\u003c/strong\\u003eCharacteristics of 5 patients with recurrent hypertensive encephalopathy\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"630\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGender\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eUnderlying diseases\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePost-HSCT\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSmall vessel vasculitis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eImaging\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEpisodes\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eBeta thalassemia major\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e✓\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003ePRES\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eEnd-stage kidney disease from microscopic polyangiitis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e✓\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003ePRES\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eSLE with LN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e✓\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003ePRES\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eSLE with LN\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e✓\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003ePRES\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 70px;\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003eDyskeratosis congenita\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 62px;\\\"\\u003e\\n \\u003cp\\u003e✓\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 99px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 68px;\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 114px;\\\"\\u003e\\n \\u003cp\\u003eAtypical PRES\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 84px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eHSCT, hematopoietic stem cell transplantation; SLE, systemic lupus erythematosus; LN, lupus nephritis; PRES, posterior reversible encephalopathy syndrome\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4\\u0026nbsp;\\u003c/strong\\u003eClinical parameters at the first episode between the recurrent and non-recurrent groups\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"623\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameters\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-recurrent\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 48)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eRecurrent\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N = 5)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ep-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eAge (years), mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e9.19 (4.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e11.8 (2.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.157\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eSmall vessel vasculitis or CNI used in post-HSCT; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e17 (35.42%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e5 (100%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.009\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eKidney diseases; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e24 (50%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e3 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.670\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eSBP index, mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e1.36 (0.22)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e1.22 (0.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.152\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eDBP index, mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e1.40 (0.33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e1.18 (0.14)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.120\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eNumbers of CT lesions, median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e1 (0-2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e2.5 (2-3.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.115\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eDuration of ASM, median (IQR)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e63.5 (13-293)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e372 (187-293)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.889\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eDuration of follow-up (months); mean (SD)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e51.04 (43.81)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e37.6 (54.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.525\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 299px;\\\"\\u003e\\n \\u003cp\\u003eSurvival at last follow-up; N (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 115px;\\\"\\u003e\\n \\u003cp\\u003e41 (85.4%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 133px;\\\"\\u003e\\n \\u003cp\\u003e3 (60%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 76px;\\\"\\u003e\\n \\u003cp\\u003e0.196\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eSD, standard deviation; IQR, inter-quartile range; HSCT, hematopoietic stem cell transplantation; SBP, systolic blood pressure; DBP, diastolic blood pressure; CT, computerized tomography; ASM, anti-seizure medications\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe present study highlights insights into the clinical characteristics and outcomes of pediatric HE. The kidney group experienced HE at an older age, was predominantly female, developed an episode of HE earlier, and required a higher number of anti-hypertensive medications than the non-kidney group. Almost 10% of patients developed recurrent episodes of HE, and this was seen as more common in patients with small vessel vasculitis or post-HSCT.\\u003c/p\\u003e \\u003cp\\u003eThere are limited data on the clinical outcomes of children with HE. Most of the previous studies were retrospectively conducted in a single center. In the present study, most patients in the kidney group were older females with lupus nephritis compared to the non-kidney group, which is consistent with the previous study in Thailand.[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] However, another study in Korea[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] revealed that the kidney group had a younger age. This discrepancy may be attributed to differences in the causes of hypertension between the studies. In the latter study, the common cause of hypertension in the kidney group was renal artery stenosis, with a lesser proportion being lupus nephritis. In addition, the present study revealed that the kidney group developed HE earlier after diagnosis of the underlying diseases and required a higher number of anti-hypertensive medications than those in the non-kidney group. At the first HE episode, the kidney group showed a trend toward higher systolic blood pressure than the non-kidney group. These findings were also observed in the previous studies[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. Altogether, these findings emphasize the importance of monitoring and early intervention in pediatric patients, especially those with kidney diseases, to prevent HE.\\u003c/p\\u003e \\u003cp\\u003eSeizure was the most common presentation in the present study, with generalized tonic-clonic being the most common semiology occurring in 75% of patients. The previous studies also reported that 65\\u0026ndash;93% of patients presented with generalized tonic-clonic seizures.[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR11\\\" citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] The non-kidney group in the present study showed lower white blood cell and platelet numbers than the kidney group. This could be explained by the fact that most patients in the non-kidney group had hematologic or oncologic diseases. Brain imaging was performed in nearly all patients, but only half had an EEG study. Abnormalities detected from the neuroimaging or EEG were not significantly different between the kidney and non-kidney groups, which was consistent with the previous study [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Another study by Ahn et al reported that all 9 patients in the kidney group had abnormal MRI findings and 6 had typical PRES lesions, but only 5 out of 8 non-kidney patients had abnormal MRI [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe present study revealed that nearly 10% of patients had recurrent HE episodes, but the proportion of patients with kidney diseases was comparable between the recurrent and non-recurrent groups. Another study[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e] reported that 25% (4 out of 16) of patients had recurrent HE episodes, and all 4 patients had kidney diseases. The present study observed that about 23% (5 out of 22) of patients with small vessel vasculitis or those who received HSCT had recurrent HE episodes. As the pathogenesis of HE is related to the disruption of endothelial cells commonly found in patients with small vessel vasculitis or post-HSCT being on calcineurin inhibitors, we postulated that this may explain why these two conditions share a common risk of recurrent HE episodes. Though not statistically significant, patients with recurrent HE episodes required a longer duration of ASM use and exhibited a lower survival rate, highlighting the poor prognosis associated with recurrent HE. The kidney and non-kidney groups had similar rates of abnormal CT and MRI findings during HE episodes. However, between the non-recurrent and recurrent HE groups, those with recurrent HE episodes had more CT lesions, suggesting that recurrent episodes may cause further brain damage.\\u003c/p\\u003e \\u003cp\\u003eThe present study described the clinical characteristics and outcomes of pediatric patients with HE with a larger number than reported in the previous studies[\\u003cspan additionalcitationids=\\\"CR7\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. We also noted a group of patients with recurrent HE episodes, particularly in patients with small vessel vasculitis or post-HSCT. However, the present study had some limitations. Firstly, only a small proportion of patients with follow-up imaging and EEGs. Secondly, the doses of steroids and other medications that might be related to the development of hypertension were not thoroughly reviewed. Thirdly, the number of patients with recurrent HE episodes was small, multivariate analysis for the recurrence risk was not applicable for the present study.\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, the present study provides valuable information about the characteristics and outcomes of pediatric HE. Key findings include (1) patients with kidney diseases were older and developed HE at an earlier age compared to those without kidney diseases; (2) No difference in clinical manifestations, duration of ASM, and survival was detected between the kidney and non-kidney groups; (3) The recurrent HE group had a higher proportion of patients with small vessel vasculitis or post-HSCT. These findings highlight the importance of early recognition, blood pressure management, and targeted interventions for high-risk pediatric populations. In addition, patients with either small vessel vasculitis or calcineurin inhibitor used in post-HSCT who have developed an episode of HE should be carefully monitored for blood pressure as they are at risk of recurrent episodes of HE.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eHE, hypertensive encephalopathy; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; CT, computerized tomography; MRI, magnetic resonance imaging; PRES, posterior reversible encephalopathy syndrome; CNS, central nervous system; EEG, electroencephalography; HSCT, hematopoietic stem cell transplantation; SLE, systemic lupus erythematosus; LN, lupus nephritis; PRES, posterior reversible encephalopathy syndrome\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe present study was approved, and informed consent was waived by the Ethics Committee for Human Research, Faculty of Medicine Ramathibodi Hospital, Mahidol University (MURA 2023/373) due to the retrospective design of the present study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompleting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare no conflict of interest relevant to this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eBW, CK, NN, SC, PS, KT and KP had substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; BW, CK and KP had significant contributions to drafting the article and revising it critically for important intellectual content; BW, CK, NN, SC, PS, KT and KP had approved the manuscript of the version to be published.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors are grateful to the Department of Pediatrics at Ramathibodi Hospital Mahidol University.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eRaina R, Mahajan Z, Sharma A, Chakraborty R, Mahajan S, Sethi SK, Kapur G, Kaelber D: \\u003cstrong\\u003eHypertensive Crisis in Pediatric Patients: An Overview\\u003c/strong\\u003e. \\u003cem\\u003eFrontiers in Pediatrics \\u003c/em\\u003e2020, \\u003cstrong\\u003e8\\u003c/strong\\u003e.\\u003c/li\\u003e\\n\\u003cli\\u003eSeeman T, Hamdani G, Mitsnefes M: \\u003cstrong\\u003eHypertensive crisis in children and adolescents\\u003c/strong\\u003e. \\u003cem\\u003ePediatr Nephrol \\u003c/em\\u003e2019, \\u003cstrong\\u003e34\\u003c/strong\\u003e(12):2523-2537.\\u003c/li\\u003e\\n\\u003cli\\u003eSharma S, Tiwari S, Yadav T, Saini L, Mittal A, Khera D, Garg PK, Khera PS: \\u003cstrong\\u003eMagnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation\\u003c/strong\\u003e. \\u003cem\\u003ePediatr Radiol \\u003c/em\\u003e2024, \\u003cstrong\\u003e54\\u003c/strong\\u003e(11):1884-1895.\\u003c/li\\u003e\\n\\u003cli\\u003eHalbach SM, Stein D: \\u003cstrong\\u003ePosterior Reversible Encephalopathy Syndrome in Children and Adolescents\\u003c/strong\\u003e. \\u003cem\\u003eCurr Hypertens Rep \\u003c/em\\u003e2024, \\u003cstrong\\u003e26\\u003c/strong\\u003e(8):349-354.\\u003c/li\\u003e\\n\\u003cli\\u003eHilal K, Khandwala K, Sajjad N, Kaleemi R, Malik AA, Mohsin S, Ibrahim SH: \\u003cstrong\\u003ePaediatric posterior reversible encephalopathy syndrome: is there an association of blood pressure with imaging severity and atypical magnetic resonance characteristics?\\u003c/strong\\u003e \\u003cem\\u003ePediatr Radiol \\u003c/em\\u003e2022, \\u003cstrong\\u003e52\\u003c/strong\\u003e(13):2610-2619.\\u003c/li\\u003e\\n\\u003cli\\u003eAyg\\u0026uuml;nes U, Sasmaz HI, Arpacı T, Akbaş T, \\u0026Ouml;zcan N, Antmen AB: \\u003cstrong\\u003eClinical and Radiological Characteristics of Classical and Variant Type of Posterior Reversible Encephalopathy Syndrome on Prognosis Following Hematopoietic Stem Cell Transplantation in Pediatric Patients: A Single-Center Experience\\u003c/strong\\u003e. \\u003cem\\u003eExp Clin Transplant \\u003c/em\\u003e2024, \\u003cstrong\\u003e22\\u003c/strong\\u003e(10):800-809.\\u003c/li\\u003e\\n\\u003cli\\u003eVirojtriratana T, Hongsawong N, Wiwattanadittakul N, Katanyuwong K, Chartapisak W, Sanguansermsri C: \\u003cstrong\\u003eComparison of Clinical Manifestations, Laboratory, Neuroimaging Findings, and Outcomes in Children With Posterior Reversible Encephalopathy Syndrome (PRES) in Children With and Without Renal Disease\\u003c/strong\\u003e. \\u003cem\\u003ePediatr Neurol \\u003c/em\\u003e2022, \\u003cstrong\\u003e134\\u003c/strong\\u003e:37-44.\\u003c/li\\u003e\\n\\u003cli\\u003eAhn CH, Han SA, Kong YH, Kim SJ: \\u003cstrong\\u003eClinical characteristics of hypertensive encephalopathy in pediatric patients\\u003c/strong\\u003e. \\u003cem\\u003eKorean J Pediatr \\u003c/em\\u003e2017, \\u003cstrong\\u003e60\\u003c/strong\\u003e(8):266-271.\\u003c/li\\u003e\\n\\u003cli\\u003eSchwartz GJ, Mu\\u0026ntilde;oz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL: \\u003cstrong\\u003eNew equations to estimate GFR in children with CKD\\u003c/strong\\u003e. \\u003cem\\u003eJ Am Soc Nephrol \\u003c/em\\u003e2009, \\u003cstrong\\u003e20\\u003c/strong\\u003e(3):629-637.\\u003c/li\\u003e\\n\\u003cli\\u003eAjmi H, Brahim J, Mabrouk S, Ben Abdallah A, Zouari N, Majdoub F, Nouir S, Hasni I, Ben Cheikh Y, Chemli J\\u003cem\\u003e et al\\u003c/em\\u003e: \\u003cstrong\\u003eClinical and radiological findings of posterior reversible encephalopathy syndrome in children: About 16 children hospitalized in the pediatric department of a Tunisian tertiary care hospital\\u003c/strong\\u003e. \\u003cem\\u003eEur J Paediatr Neurol \\u003c/em\\u003e2023, \\u003cstrong\\u003e43\\u003c/strong\\u003e:18-26.\\u003c/li\\u003e\\n\\u003cli\\u003eG\\u0026uuml;n E, Akova B, Botan E, \\u0026Ccedil;elik DB, Balaban B, \\u0026Ouml;zen H, Gencay AG, Bektaş \\u0026Ouml;, Fitoz S, Kendirli T: \\u003cstrong\\u003eClinical features and outcomes of children admitted to the pediatric intensive care unit due to posterior reversible encephalopathy syndrome\\u003c/strong\\u003e. \\u003cem\\u003eClin Neurol Neurosurg \\u003c/em\\u003e2022, \\u003cstrong\\u003e222\\u003c/strong\\u003e:107476.\\u003c/li\\u003e\\n\\u003cli\\u003eBa H, Peng H, Xu L, Qin Y, Wang H: \\u003cstrong\\u003eClinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis-A Retrospective, Single-Center Study in China\\u003c/strong\\u003e. \\u003cem\\u003eFront Cardiovasc Med \\u003c/em\\u003e2022, \\u003cstrong\\u003e9\\u003c/strong\\u003e:891804.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Hypertensive encephalopathy, outcomes, children, characteristics\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6222883/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6222883/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHypertensive encephalopathy (HE) is characterized by a severe increase in blood pressure, leading to neurological symptoms such as severe headache, seizure, and mental status change. The underlying pathophysiology includes a disruption of the cerebral endothelium and blood-brain barrier, leading to cerebral edema and microhemorrhages. Prompt medical treatment is crucial, often leading to full recovery without long-term neurological deficits. However, untreated cases can result in serious complications. This study aimed to describe the clinical characteristics and outcomes of children who developed HE.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMaterials and Methods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA retrospective review of medical records in patients aged \\u0026lt; 20 years diagnosed with HE in Ramathibodi Hospital was conducted. Data were collected, including demographics, underlying conditions, clinical presentations, blood pressure levels during HE, medication use, diagnostic investigations, and outcomes. Patients with pre-existing neurological symptoms or incomplete data were excluded. Data between the groups with kidney diseases and non-kidney diseases were compared.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFifty-three patients (26 males) were included with a mean age of 8.9 ± 4 years and a median follow-up time of 47.8 months. Kidney disease (51%) was the most common cause of hypertension. Patients with kidney disease were older (10.3 vs. 7.5 years, \\u003cem\\u003ep\\u003c/em\\u003e = 0.01), had a shorter duration between the diagnosis of underlying conditions and development of HE (70 vs. 457 days, \\u003cem\\u003ep\\u003c/em\\u003e = 0.04), and a larger proportion of females (66.7% vs. 34.6%, \\u003cem\\u003ep\\u003c/em\\u003e = 0.02). Neither clinical manifestations such as generalized tonic-clonic seizures, headaches, and mental status changes nor survival were different between the kidney and non-kidney groups. Five patients developed recurrent episodes of HE. The recurrent group had a higher proportion of patients with underlying diseases involving endothelial injuries, such as small vessel vasculitis and calcineurin inhibitors used in post-hematopoietic stem cell transplantation (HSCT) (100% vs. 35.4%, \\u003cem\\u003ep\\u003c/em\\u003e = 0.009) than the non-recurrent groups.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003ePatients with kidney diseases were older and developed HE earlier, but there was no difference in survival between the kidney and non-kidney groups. The group with recurrent episodes of HE was more commonly detected in patients with small vessel vasculitis and calcineurin inhibitors used in post-HSCT, prompting the pediatricians to be vigilant for blood pressure control in these patients.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eClinical trial number\\u003c/strong\\u003e: not applicable\\u003c/p\\u003e\",\"manuscriptTitle\":\"Clinical Characteristics and Outcomes of Children with Hypertensive Encephalopathy\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-04-03 04:56:41\",\"doi\":\"10.21203/rs.3.rs-6222883/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-04-07T10:49:45+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-04-01T10:21:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-03-30T10:42:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"95586677273041847413060591503215181247\",\"date\":\"2025-03-28T05:31:16+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-03-27T19:14:41+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"24262184717872583799001327759024719965\",\"date\":\"2025-03-27T16:43:15+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"92557494865608084739547129334431055353\",\"date\":\"2025-03-27T09:31:27+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"329139910929688289920266296237178408439\",\"date\":\"2025-03-25T10:59:46+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"246890879405719814343755829427731200039\",\"date\":\"2025-03-25T09:30:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-03-25T09:12:37+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-03-24T11:49:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-03-24T11:44:42+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-03-22T02:24:57+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Pediatrics\",\"date\":\"2025-03-22T02:23:50+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-pediatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bped\",\"sideBox\":\"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bped/default.aspx\",\"title\":\"BMC Pediatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"a7ec2e72-dade-4779-a680-4c11a0c8e275\",\"owner\":[],\"postedDate\":\"April 3rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-08-07T07:12:42+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-6222883\",\"link\":\"https://doi.org/10.1186/s12887-025-05909-w\",\"journal\":{\"identity\":\"bmc-pediatrics\",\"isVorOnly\":false,\"title\":\"BMC Pediatrics\"},\"publishedOn\":\"2025-07-17 16:05:37\",\"publishedOnDateReadable\":\"July 17th, 2025\"},\"versionCreatedAt\":\"2025-04-03 04:56:41\",\"video\":\"\",\"vorDoi\":\"10.1186/s12887-025-05909-w\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12887-025-05909-w\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6222883\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6222883\",\"identity\":\"rs-6222883\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}