Multidisciplinary Clinical Case Study

Uremic Pericarditis: Distinguishing Features in a Now-Uncommon Clinical Syndrome

Authors: Daniel Restrepo, MD, Muthiah Vaduganathan, MD, MPH, Andrew Z. Fenves, MD

Abstract

We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated a fibrinous pericardial effusion. The patient was initiated on hemodialysis for hyperkalemia, metabolic acidosis, and uremia. He subsequently developed shock from cardiac tamponade, which required emergent pericardiocentesis. He was notably without tachycardia while he was hypotensive, and his admission electrocardiogram did not show typical ST- or PR-segment changes typically associated with acute pericarditis. This case highlights important differences between uremic pericarditis and other prevalent types of acute pericarditis, including the lack of tachycardia during tamponade and normal electrocardiography. Uremic pericarditis is now a less common diagnosis. It is often seen in the setting of previously undiagnosed advanced kidney disease or when patients are ineffectively dialyzed. Given its atypical features, low incidence, and adverse attendant complications, internists must maintain a high degree of suspicion to correctly diagnose acute uremic pericarditis.

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