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Posts Tagged ‘uremic pericarditis’

Pericardium is a  fine  biological sensor. It   makes   noise when the kidney is in distress .

We call   this as uremic pericardial  rub .  This is not a universal phenomenon in renal failure.

Occurs in about 10% of renal failure .

Mechanism

  • Chemical pericarditis . Uremic middle molecules ?
  • Dialysis related pericarditis
  • Associated infection

Two  themes can occur .

  • Pericarditis without effusion .
  • Effusion without pericarditis

The later is more common .

Is it a exudate or transudate ?

Usually a transudate. Protein accumulation may occur .

Hemorrhagic or non hemorrhagic effusion ?

Again both can occur. Platelet dysfunction is well known feature of renal failure .Bleeding into pericardial space  even a few cc of blood is suffice ,  to color the entire effusion  red  .

ECG features of uremic pericarditis , how is it different ?

The uremic pericarditis  less often results  in classical ST elevation  (concavity upwards)  instead the hyperkalemia features dominate , if present.

The reason for less conspicuous ST  elevation is due to the relative lack of  epicardial electrical injury . Further , the pericardial fluid  is enriched with  oppositely charged uremic molecules  which neutralise’s the

electrical gradient .

Relationship  of pericarditis  with acuteness of renal failure

Though it can occur in any form of uremia.It is more often observed in rapidly worsening renal failure

Relationship to dialysis

  • Presence of  pericardial rub is a classical indication for dialysis .(But not presence of effusion per se  )
  • While pericardial rub disappears in many ,  a  pericardial  rub that is  exclusively  observed  for the first time  after dialysis is well known .
  • The exact mechanism is not  clear . One explanation could be  the pericardial   surfaces gets approximated once pericardial fluid is filtered by dialysis.

Complication

Tamponade is common .Usually tolerated well till late stages as  LVH  and mild PAH are common which resists fluid compression.

Constriction can rarely occur. Tuberculosis can co exist.

Management

  • Indomethacin /Other NSAIDS
  • Steroids
  • Pericardiocenetesis
  • Surgery may be needed if recurrent pericarditis occur

Patients with pericardial rub should be dialysed heparin free .

Reference

Review article

http://emedicine.medscape.com/article/244810-overview

http://circ.ahajournals.org/cgi/content/short/53/5/896

Surgical management

http://ats.ctsnetjournals.org/cgi/content/abstract/22/6/588

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