[Uremic pericarditis complicating cardiac tamponade: a case report]

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Diabetic nephropathy is a progressive kidney disease often requiring renal replacement therapy.
• Peritoneal dialysis is a common treatment modality for end-stage renal disease.
• Cardiac tamponade is a life-threatening condition caused by fluid accumulation in the pericardium.

Observation:

• A patient with diabetic nephropathy experienced insufficient dialysis efficiency and worsening uremia despite increased peritoneal dialysis fluid.
• The patient developed symptoms including nausea, hypotension, and echocardiographic evidence of massive pericardial effusion and right ventricular collapse, consistent with cardiac tamponade.
• Bloody pericardial effusion was drained, and urgent hemodialysis was initiated.

Findings:

• Hemodialysis led to a decrease in pericardial effusion, resolution of gastrointestinal symptoms, and improved blood urea nitrogen and serum creatinine levels.
• Uremic pericarditis was identified as the cause of cardiac tamponade, a rare complication in the era of advanced hemodialysis.
• Differential diagnoses including infectious disease, collagen disease, malignant disease, and aortic dissection were systematically excluded.

Implications:

• This case underscores the importance of recognizing and managing uremic pericarditis, even in patients undergoing dialysis.
• It highlights the critical role of hemodialysis in treating cardiac tamponade secondary to uremic pericarditis.
• The rarity of this complication emphasizes the effectiveness of modern dialysis techniques in preventing severe uremic manifestations.