CONSTRICTIVE URAEMIC PERICARDITIS IN ACUTE KIDNEY INJURY
Gina Davis1, SRADHA KOTWAL1,2, SIMON EGGLETON1, JONATHAN ERLICH1 1Prince of Wales Hospital, Randwick, NSW, Australia2Renal and Metabolic Division, The George Institute for Global Health, UNSW, Sydney, NSW, Australia
Abstract
Background: Uraemic pericarditis is a known complication of advanced, untreated chronic kidney disease. Uncommonly, it manifests as constrictive pericarditis, where a thickened, fibrotic pericardium impedes diastolic filling. However, there have been no reports of constrictive uraemic pericarditis in acute kidney injury.
Case Report: A 61-year-old man, with no known history of renal disease, presented acutely dyspnoeic, with a four-day history of pleuritic chest pain. He had a history of ischaemic heart disease, no recent medication changes, or nephrotoxic insults and reported normal urine output, with no lower urinary tract symptoms. At presentation, his creatinine was 1,540umol/L, eGFR 3mL/min/1.73m2, urea 73.1mmol/L, potassium 6.6mmol/L and bicarbonate 8mmol/L, from a previous baseline creatinine of 80umol/L, eGFR >90mL/min/1.73m2, five years prior. Urine protein/creatinine ratio was 36mg/mmol, without haematuria and a non-contrast CT abdomen demonstrated bilateral hydroureteronephrosis, with an enlarged prostate (approximately 90mLs). Transthoracic echocardiogram showed a moderate, echo-dense pericardial effusion, with marked interventricular septal interdependence and tricuspid and mitral variation with respiration. An indwelling catheter was inserted, and he received continuous veno-venous haemodialysis for less than 24 hours. Oral prednisone 50mg daily was commenced and his constrictive pericarditis thought secondary to uraemia, given no other causes were identified. His kidney function continues to improve.
Conclusions: Uraemic pericarditis is a very uncommon complication of acute kidney injury, with constrictive pericarditis not reported. Constrictive pericarditis presents additional management challenges, given the fluid shifts associated with dialysis and typical treatment, including nonsteroidal anti-inflammatory drugs and colchicine are relatively contraindicated in the setting of acute renal failure. Chronic obstruction with progressive acute on chronic kidney injury may provide a possible explanation for organised, uraemic pericarditis in this man.
Biography
Gina Davis is a Basic Physician Trainee at Prince of Wales Hospital in Sydney, with an interest in Nephrology and Palliative Care. She originally completed a Bachelor of Medical Science at the University of New South Wales and received the University Medal in Pharmacology. She received First Class Honours in Pharmacology and then completed the Undergraduate Medicine Program at the University of New South Wales.