Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report

Seo, Hye Mi; Kim, Mi‐Yeon; Kim, Hyun-woo

doi:10.1002/ccr3.2069

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…But unfortunately, to date, the optimal treatment in refractory cases has not been established. Seo et al reported a case of refractory exudative pleural effusion in patients with CKD not receiving dialysis [10].…”

Section: Discussionmentioning

confidence: 99%

Unilateral pleural effusion in chronic renal insufficiency: A clinician’s challenge

Atri¹,

Ambalavana²,

Dhanda³

et al. 2021

IJCR

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hronic kidney disease (CKD) is a condition that presents usually with fluid overload. Pleural disease is a common problem in patients with chronic renal insufficiency which may be attributed to many etiologies, including congestive heart failure, infection, the presence of diseases associated with renal and pleural manifestations (e.g. systemic lupus in erythematosus), uremic pericarditis, malignancies, and pulmonary embolism. Unilateral pleural effusion is a diagnostic challenge in CKD patients. Uremic pleuritis results from an unknown putative agent, and therefore, uremic pleuritis is a diagnosis of exclusion [1]. CASE REPORTA 66-year-old male presented to us with a complaint of shortness of breath for 4 days. It was not associated with chest pain, decreased urine output, vomiting, altered sensorium, fever, palpitations, joint pain, cough with sputum, night sweats, and weight loss. There was no history of connective tissue disease such as rheumatoid arthritis (RA). The patient is a known case of type 2 diabetes (for 22 years), hypertension (for 22 years), and CKD (3 years). He was on tab. amlodipine 10 mg OD, prazosin 10 mg OD, torsemide 20 mg BD, and linagliptin 5 mg OD. For the past 3 years, the patient was on regular medication and his renal functions remained stable, not requiring renal replacement therapy.On admission, blood pressure was 160/100 mmHg, pulse rate was 110/min, and tachypneic at rest with a saturation of 85% at room air. On general physical examination, the patient was pale and having bilateral pedal edema. Icterus, clubbing, cyanosis, and jugular venous distension were absent. Respiratory system examination revealed tracheal deviation towards the right, dull percussion notes, and reduced air entry on auscultation over the left lung field. Cardiac examination was unremarkable.Renal function tests performed 6 months back revealed creatinine 5.3 mg/dl and urea 152 mg/dl with estimated glomerular filtration rate (eGFR) of 12 ml/min/1.73 m 2 which were found worsened on this admission with creatinine 6.4 and urea 201 with eGFR 9 ml/min/1.73 m 2 . Complete hemogram revealed hemoglobin 7.1 g/dl microcytic hypochromic, total leukocyte count of 6800/mm 3 , and platelet count of 240,000/mm 3 . Liver function tests were unremarkable with albumin of 3.6 g/dl. Uric acid was 9.6 mg/dl, calcium was 7.9 mg/dl, phosphorus was 8.9 mg/dl, and normal arterial blood gas analysis. Erythrocyte sedimentation rate was 24 mm/h, Mantoux test was negative, and RA factor was negative. Digital chest X-ray revealed left-sided pleural effusion with right-sided tracheal shift with clear costophrenic angle on the right side (Fig. 1a).On thoracentesis, the pleural fluid was hemorrhagic, exudative with pleural fluid-to-serum protein ratio was 0.54(3.5/6.4), and the pleural fluid to serum lactate dehydrogenase ratio >0.6 (294/254) with lymphocytic predominance and adenosine deaminase of 9.1. No organisms were seen on Gram stain, no acid-fast bacilli were seen, and the cartridge-based nucleic acid amplification test was negative...

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Section: Discussionmentioning

confidence: 99%

Unilateral pleural effusion in chronic renal insufficiency: A clinician’s challenge

Atri¹,

Ambalavana²,

Dhanda³

et al. 2021

IJCR

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“…Alternatively, hypervolemia as a sequela of poor ultrafiltration or heart failure can also lead to transudative effusions. 9 Patients whose membranes exhibit fast solute transport rates can equilibrate solute and clear uremic toxins more rapidly, but also readily absorb dialysate dextrose, diminishing the blood-dialysate osmotic gradient and thereby weakening ultrafiltration pressure. 10 Thus, poor ultrafiltration associated with this patient's rapid transport peritoneal membrane characteristics in the setting of a diaphragmatic patency may have contributed to her presentation.…”

Section: Brown Hospital Medicinementioning

confidence: 99%

Hydrothorax with Atypical Features as a Complication of Peritoneal Dialysis: A Case Report and Literature Review

Wang

Shah

2023

Journal of Brown Hospital Medicine

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Hydrothorax is an uncommon but established complication of peritoneal dialysis, usually arising from pleuroperitoneal leak. There is currently no consensus on definitive testing or management. Thoracentesis, sclerosing agents, and either temporary or permanent discontinuation of peritoneal dialysis in favor of hemodialysis are often considered. We report an unusual case of right-sided PD-associated hydrothorax in a 54-year-old female with a history of hypertension and anemia, who presented without chest pain or dyspnea but rather with fatigue and syncope. We review the current literature on this etiology regarding underlying causes, as well as best practices for diagnosis and treatment.

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Bilateral pleural effusion: etiology, diagnostics

Стогова

2022

Pulʹmonologiâ (Mosk.)

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The problem of etiologic diagnosis of bilateral pleural effusions is important because of the relatively large number and variety of diseases accompanied by this syndrome, the complexity of diagnosis verification, and the frequent diagnostic errors. The aim of this review is to describe the spectrum of diseases causing bilateral pleural effusion and to consider a set of diagnostic measures to clarify the etiology of the process. Analysis of 60 literature sources showed that the most common causes of bilateral transudative pleural effusions are cardiac, hepatic, and renal insufficiency. Exudative bilateral pleural effusions are found in inflammatory processes in the pleura, including tuberculosis, and develop when inflammation is transmitted by contact or lymphohematogenous routes from the lungs or other organs. Bilateral localization of pleural effusion in tumor processes is observed in 5.7% of cases. Bilateral pleural effusion is seen in pulmonary embolism, diffuse connective tissue diseases, acute idiopathic pericarditis, postinfarction Dressler syndrome, after pericardotomy, and after pacemaker placement. It may be observed in such rare diseases as sarcoidosis, yellow nail syndrome, and Meigs syndrome, and may be induced by some drugs. Conclusion. The choice of therapeutic measures for bilateral pleural effusion is determined by an accurate etiological diagnosis of the underlying disease. The diagnosis should be based on the patient's clinical data and cytologic, microbiologic, and biochemical analysis of pleural fluid obtained by pleural puncture. In some cases, additional examination methods such as pleural biopsy, bronchoscopy, ultrasound, computed, magnetic resonance imaging of the chest and abdomen, and positron emission tomography are required.

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Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report

Cited by 3 publications

References 15 publications

Unilateral pleural effusion in chronic renal insufficiency: A clinician’s challenge

Unilateral pleural effusion in chronic renal insufficiency: A clinician’s challenge

Hydrothorax with Atypical Features as a Complication of Peritoneal Dialysis: A Case Report and Literature Review

Bilateral pleural effusion: etiology, diagnostics

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