Cardiac tamponade caused by uremic pericarditis in a patient with end-stage renal disease due to diabetic nephropathy

Abstract

A 39-year-old man with advanced diabetic nephropathy was admitted to our hospital because of worsening of renal dysfunction and anasarca. He was diagnosed as having diabetes mellitus at the age of 36, and then required repeated hospitalization because of poorly controlled nephrotic syndrome due to diabetic nephropathy. After an episode of severe diarrhea, he experienced oliguria, dyspnea on exertion and marked leg edema. The levels of serum creatinine and blood urea nitrogen were significantly elevated and he was admitted for the initiation of emergent hemodialysis therapy. Chest X-ray and echocardiographic findings showed cardiomegaly with moderate pericardial effusion. Despite aggressive volume reduction, the cardiothoracic index gradually increased on chest X-ray. Blood pressure then gradually decreased, and he went into shock on the tenth hospital day. Echocardiography demonstrated cardiac tamponade with massive pericardial effusion and collapse of the right ventricle. Pericardiocentesis and pericardial drainage were performed, which demonstrated massive bloody pericardial effusion. We diagnosed the patient as having uremic pericarditis based on the clinical course, serological data and puncture fluid analysis, and performed intensive daily hemodiafiltration. After treatment, the amount of pericardial effusion decreased gradually and clinical symptoms improved.
When pericardial effusion with tamponade is detected in patients with acute renal failure, those with chronic renal failure around the initiation of dialysis, or those with insufficient dialysis efficacy, uremic pericarditis should be considered along with volume overload, infectious disease, collagen disease or malignancy.