ESPN 51th Annual Meeting

ESPN 2018


 
Uremic pericarditis as a rare case in child with chronic kidney disease
AGNIESZKA PUKAJLO-MARCZYK 1 ANNA JAKUBOWSKA 1 KATARZYNA KILIS-PSTRUSINSKA 1 DANUTA ZWOLINSKA 1

1- WROCLAW MEDICAL UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY
 
Introduction:

Among the complications of chronic kidney disease (CKD), uremic pericarditis is currently very rarely described,  especially in the pediatric population.

 

Material and methods:

Our report describes  the case of uremic pericarditis in 11-year-old boy with chronic kidney failure to remind  its  clinical manifestations and with hope to help find timely recognition of its presence. He was admitted to Emergency Department because of his poor state and chest pain. 

 

Results:

First lab investigation showed anemia, very high concentration of serum urea, creatinine, uric acid, severe metabolic acidosis and elevated inflammation parameters. The hemodialysis was initiated.  On the 2nd day of hospitalization a large amount of pericardial fluid was shown in ultrasound, without  hemodynamic effects. The treatment was followed by steroids and diuretics with improvement.  In the further course of the disease, enlargement of the liver and the occurrence of systolic murmur were observed  - pericardial friction rub was suspected.  After 2 weeks, despite continuation of treatment,  a sudden worsening of the clinical condition was observed and tachycardia, deaf and quiet tones of the heart, dyspnoea, pain in the area of ​​the left shoulder were found in physical examination. Laboratory test showed a rapid increase in BNP, in chest X-ray enlarged silhouette of the heart with a rounded shape was revealed and in ultrasound the heart was compressed and surrounded by a lot of fluid. An attempt to decompress the tamponade with pericardial puncture was unsuccessful. The child developed a cardiogenic shock and urgent indications for cardiac surgery have been established. Surgery was successful. The child is still hemodialyzed and no cardiac complications are observed.

 

Conclusions:

Uremic pericarditis it is usually seen in predialysis patients, so timely recognition of CKD is crucial. In our patient diagnosis of CKD was delayed and this rare complication was revealed after 2 weeks of proper therapy.