Uremic Pericarditis

Bailey, George; Hampers, Constantine L.; Hager, Edward B.; Merrill, John P.

doi:10.1161/01.cir.38.3.582

Cited by 105 publications

(21 citation statements)

References 18 publications

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“…Pericarditis was demonstrated in 40 of 125 patients with terminal uremia (32 %). This frequency of occurrence is in accordance with the findings of others (2,3,12). In five out of the total 40 cases of uremic pericarditis, life-threatening acute pericardial constriction due to cardiac tamponade developed.…”

Section: Discussionsupporting

confidence: 91%

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Uremic Pericarditis

Skov

Hansen

Spencer

1969

Journal of Internal Medicine

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The frequency of uremic pericarditis and complicating cardiac tamponade has been determined in a series of 125 patients in terminal uremia. Forty (32%) were found to have uremic pericarditis, and five of these patients (12.5%) developed a pericardial effusion sufficient to produce cardiac tamponade. The diagnosis uremic pericarditis had been made during life in 32 of the 40 patients on the presence of a pericardial friction rub, which was found to be the most constant symptom of pericarditis. Demonstration of acute pericardial constriction was solely clinical: rapidly developing cardiac insufficiency in a clinical situation where hypertensive heart disease, overhydration and severe anemia could be ruled out as etiologic factors. Seven of the patients with uremic pericarditis were treated with regular hemodialysis using universal heparinization. One patient developed cardiac tamponade in connection with his first hemodialysis. All the rest of the hemodialyses in this patient and in the other patients were without complications. The risk of universal heparinization must therefore be considered to be minimal. The size and shape of the heart became normal in three of the seven patients and the pericardial friction rub disappeared in all of them during intermittent hemodialysis. It is thus possible with effective hemodialysis to treat uremic pericarditis and complicating pericardial effusion so that renal allotransplantation can be carried out. Eight patients with uremic pericarditis in this series, including two with cardiac tamponade, have received renal transplants. Seven of these patients are alive, one three years post‐transplant.

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Section: Discussionsupporting

confidence: 91%

“…In most cases uremic pericarditis provides an indication for hemodialysis; however, universal heparinization in connection with dialysis has been mentioned as a causative factor in the development of hemopericardium (1,2,3,8,9).…”

Section: Discussionmentioning

confidence: 99%

Uremic Pericarditis

Skov

Hansen

Spencer

1969

Journal of Internal Medicine

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“…This fibrotic state often manifests as a rough granular surface with irregular, scattered adhesions between parietal and visceral pericardium in a “ bread and butter” pattern[ 8 , 11 ]. However, densely adherent pericarditis and gross pericardial thickening with organizing fibrinous pericarditis have been found at autopsy in cases of uraemic disease[ 12 ].…”

Section: Clinical Models Of Post Inflammatory Pericarditismentioning

confidence: 99%

Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

Ramasamy¹,

Mayosi²,

Sturrock³

et al. 2018

WJC

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This review article aims to: (1) discern from the literature the immune and inflammatory processes occurring in the pericardium following injury; and (2) to delve into the molecular mechanisms which may play a role in the progression to constrictive pericarditis. Pericarditis arises as a result of a wide spectrum of pathologies of both infectious and non-infectious aetiology, which lead to various degrees of fibrogenesis. Current understanding of the sequence of molecular events leading to pathological manifestations of constrictive pericarditis is poor. The identification of key mechanisms and pathways common to most fibrotic events in the pericardium can aid in the design and development of novel interventions for the prevention and management of constriction. We have identified through this review various cellular events and signalling cascades which are likely to contribute to the pathological fibrotic phenotype. An initial classical pattern of inflammation arises as a result of insult to the pericardium and can exacerbate into an exaggerated or prolonged inflammatory state. Whilst the implication of major drivers of inflammation and fibrosis such as tumour necrosis factor and transforming growth factor β were foreseeable, the identification of pericardial deregulation of other mediators (basic fibroblast growth factor, galectin-3 and the tetrapeptide Ac-SDKP) provides important avenues for further research.

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“…It was first described by Richard Bright in 1836. Its incidence in the early days of dialysis was high – 41% in a study of 83 patients in Peter Brigham Hospital [ 2 ] and 12.5% in another study of 125 patients from Denmark [ 3 ]. However, more recently, its incidence has decreased to about 5–20% in chronic hemodialysis patients [ 4 , 5 ], perhaps due to more efficient hemodialysis therapy.…”

Section: Discussionmentioning

confidence: 99%

Uremic Pericarditis: A Report of 30 Cases and Review of the Literature

Sadjadi

Mashahdian

2014

Am J Case Rep

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Case seriesPatient: Male, 71 • Male, 69 • Female, 49Final Diagnosis: Uremic pericarditisSymptoms: —Medication: —Clinical Procedure: HemodialysisSpecialty: NephrologyObjective:Rare diseaseBackground:Uremic pericarditis, common at one time among dialysis patients, has become a rare entity in recent years. Due to its low incidence, its recognition has gained importance among internists, cardiologists, and nephrologists. It can be seen in predialysis patients and in dialysis patients who are on hemodialysis or peritoneal dialysis.Case Report:We report 3 cases of uremic pericarditis and their presenting manifestations and review 30 cases we have treated. Among these patients, the traditional findings among patients with acute pericarditis such as chest pain, fever, electrocardiographic changes, and leukocytosis are uncommon. Pericardial friction rub has a relatively high incidence but its differentiation by an untrained ear, especially by a non-cardiologist, could be a major problem. Not infrequently, it is complicated by pre-tamponade or tamponade, requiring pericardiocentesis or pericardial surgery.Conclusions:Uremic pericarditis is a treatable, but not always a preventable, condition. Timely recognition of its presence and its efficient management are essential elements of successful treatment.

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Uremic Pericarditis

Cited by 105 publications

References 18 publications

Uremic Pericarditis

Uremic Pericarditis

Established and novel pathophysiological mechanisms of pericardial injury and constrictive pericarditis

Uremic Pericarditis: A Report of 30 Cases and Review of the Literature

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