Uremic pleuritis diagnosed by thoracoscopic pleural biopsy in three patients undergoing maintenance hemodialysis who presented with hemorrhagic pleural effusion

Abstract

We present the cases of three patients who were undergoing maintenance hemodialysis and were diagnosed with uremic pleuritis after thoracoscopic pleural biopsy examinations. The patients had been receiving hemodialysis treatment for 3 to 37 years and were suffering from dyspnea with pleural effusion. In each case, the pleural fluid appeared hemorrhagic and exudative ; cultures of the fluid were negative for bacteria, including Mycobacterium tuberculosis ; and cytological examinations did not detect malignancy. Each pleural biopsy specimen showed fibrous thickening and inflammatory cell infiltration, without any findings that were indicative of infectious disease or malignancy. Based on these findings, we diagnosed the patients with uremic pleuritis. The pleural effusion did not respond to intensive hemodialysis treatment or a change in the anticoagulant drug used for hemodialysis in any case. Furthermore, the two patients who received anti-tuberculosis treatment did not exhibit any improvement in their pleural effusion and died of respiratory failure combined with pneumonia. The remaining patient was given oral prednisolone, which resulted in an improvement in their pleural effusion and enabled them to breathe normally. In conclusion, thoracoscopic pleural biopsy is helpful for diagnosing uremic pleuritis. Although refractory uremic pleuritis exhibits a poor prognosis, corticosteroid treatment might improve the outcomes of this condition.