Uremic pericarditis

A type of pericarditis associated with kidney failure

Uremic pericarditis is a form of pericarditis that occurs in patients with uremia, a condition associated with advanced kidney failure. It is characterized by inflammation of the pericardium, the fibrous sac surrounding the heart.

Pathophysiology

Uremic pericarditis is primarily caused by the accumulation of uremic toxins in the blood due to impaired kidney function. These toxins can lead to inflammation of the pericardium. The condition is often seen in patients with chronic kidney disease (CKD) or those undergoing dialysis.

Clinical features

Patients with uremic pericarditis may present with chest pain, which is typically sharp and pleuritic in nature. The pain may worsen with deep breathing or lying flat and improve when sitting up or leaning forward. Other symptoms can include fever, dyspnea (shortness of breath), and a pericardial friction rub, which is a scratching or grating sound heard with a stethoscope.

Diagnosis

The diagnosis of uremic pericarditis is often clinical, supported by laboratory findings of elevated blood urea nitrogen (BUN) and creatinine levels, indicating renal failure. Electrocardiogram (ECG) changes may show diffuse ST-segment elevation, although these are not specific to uremic pericarditis. Echocardiography can be used to assess for the presence of a pericardial effusion.

Treatment

The primary treatment for uremic pericarditis is the initiation or intensification of dialysis to remove uremic toxins. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids may be used to manage inflammation and pain, although their use must be carefully monitored in patients with renal impairment.

Prognosis

With appropriate treatment, the prognosis for uremic pericarditis is generally good. However, if left untreated, it can lead to complications such as cardiac tamponade, a life-threatening condition where fluid accumulation in the pericardial space compresses the heart.

Related pages

• Pericarditis
• Chronic kidney disease
• Dialysis

References

• Levy, M., & Lichtstein, D. M. (2005). Pericarditis in end-stage renal disease. Seminars in Dialysis, 18(2), 137-144.
• Reddy, P. S., & Curtiss, E. I. (1983). Uremic pericarditis: A review. American Heart Journal, 106(5), 1135-1140.

Fibrinous pericarditis, which can be seen in uremic pericarditis.