ANASARCA AND PERICARDIAL EFFUSION ASSOCIATED WITH MINOXIDIL USE IN END STAGE KIDNEY DISEASE (ESKD) ON HAEMODIALYSIS
Dr Catherine Wilkinson1, Dr Murty Mantha1, Dr Chetana Naresh1, Dr Harris Hakim1, Dr Ibrahim Ismail1, Dr Felicity Sartain1
1Cairns Hospital, Cairns, Australia
Introduction: Minoxidil is an arteriolar vasodilator used in the treatment of refractory hypertension. We describe a case of Minoxidil associated anasarca, refractory to fluid removal due to pericardial effusion in a patient with end-stage kidney disease (ESKD) on haemodialysis.
Case Presentation: A 34-year-old female with ESKD and refractory hypertension despite achieving ideal body weight (IBW) was prescribed Minoxidil 2.5mg once daily, gradually uptitrated to 5 mg. Over the subsequent three months, she progressively developed anasarca, fatigue, shortness of breath and abdominal distention despite regular attendance at haemodialysis sessions and achieving her IBW. Serial chest radiographs demonstrated progressive increase in the cardiac silhouette consistent with the “water bottle sign” that is characteristic of pericardial effusion, confirmed on echocardiogram.
Discussion: The evolution of the patient’s clinical symptom complex in temporal association with starting Minoxidil was consistent with chronic pericardial effusion. There was no indication for pericardiocentesis or a pericardial window. Minoxidil was discontinued and her progress is being monitored.
Conclusion: Minoxidil induced pericardial effusion and anasarca, although uncommon, should be recognised in the context of failure to achieve fluid control despite optimal haemodialysis in patients being treated with Minoxidil irrespective of the dose.
Biography:
Dr Catherine Wilkinson is an Interventional Nephrologist based at Cairns Hospital. She completed her training in both North Queensland (Townsville and then Cairns) as well as a year in Adelaide undertaking experience in transplant. She is clinical lead for transplant at Cairns Hospital; and co-lead of Kidney Supportive Care. She holds recognition from the RACS Conjoint Committee in Peripheral Endovascular Therapy. She is current Chair of the Australia/NZ Committee of Interventional Nephrology (subcommittee of ANZSN). She also is current Co-Chair of the Queensland Renal Clinical Network, representing the clinical priorities of delivering renal care in regional and northern Queensland.