Uremic Pericarditis

Excerpt

The pericardium is the fibroelastic sac surrounding the heart. It is composed of two layers, visceral and parietal, that are separated by a "potential" space. Within this potential space, it is normal to have 15 to 50 mL of fluid to serve the purpose of lubrication. The term acute pericarditis refers to inflammation of this fibroelastic sac. The causes of pericarditis are wide-ranging, including infection, autoimmune processes, malignancy, and uremia.

Uremic pericarditis is an uncommon but significant complication of end-stage renal disease (ESRD). Richard Bright described it for the first time in 1836. It was more common in the early days of dialysis; however, more recently, it has become an uncommon complication of ESRD potentially because of more efficient hemodialysis therapy. In the past, it was thought that a viral illness could cause uremic pericarditis. Uremic pericarditis is fibrinous in nature with a rough fibrinous surface. When there is fluid, it is generally exudative, with an abundance of proteins and mononuclear cells.

Uremic pericarditis typically occurs in patients with end-stage renal disease and patients with severe azotemia (elevated blood urea nitrogen, BUN), typically above 60 mg/dL. Clinical features of uremic pericarditis include chest pain, particularly in the recumbent position, a pericardial rub that is often audible, and in severe cases, cardiac tamponade may be present. Initial investigations for uremic pericarditis include an electrocardiogram, which typically shows diffuse ST and T-wave elevations. Treating this condition is often by lowering BUN through dialysis.