II. Pathophysiology

  1. Occurs with Renal Failure related Uremia when GFR falls to <10-15 ml/min (especially in Diabetes Mellitus)
  2. Related to uremic toxins (metabolites, nitrogenous waste) that accumulate and inflame the Pericardium
    1. Fluid and Electrolyte shifts can also trigger Pericarditis
    2. Blood Urea Nitrogen (BUN) levels do not correlate with Uremic Pericarditis symptoms

III. Epidemiology

  1. Incidence as high as 2 to 21% of Hemodialysis patients
    1. Incidence has decreased with advances in Hemodialysis technology and techniques

IV. Types

  1. Uremic Pericarditis
    1. Pericarditis that starts before Hemodialysis is initiated (or within the first 8 weeks of Hemodialysis)
  2. Hemodialysis Associated Pericarditis
    1. Pericarditis that starts more than 8 weeks after Hemodialysis has been initiated
    2. Improves with more frequent Hemodialysis

V. Differential Diagnosis

VI. Symptoms

  1. See Pericarditis
  2. Symptomatic onset is typically more insidious and delayed than with other forms of Pericarditis
  3. Pleuritic Chest Pain
  4. Other variably present symptoms
    1. Fever
    2. Malaise
    3. Dyspnea

VIII. Labs

  1. See Pericarditis
  2. Inflammatory markers
    1. Leukocytosis
    2. C-Reactive Protein increased
    3. Erythrocyte Sedimentation Rate
  3. Serum Troponin
    1. Often elevated in End Stage Renal Disease and may be more difficult to interpret

IX. Diagnostics

  1. See EKG in Pericarditis
  2. Diffuse ST Elevation is often absent in Uremic Pericarditis

X. Imaging

XI. Management

  1. Hemodialysis
    1. Hemodialysis (and increased Hemodialysis frequency) is First-line therapy for Uremic Pericarditis
    2. Uremic Pericarditis
      1. Initiate daily Hemodialysis for 5 to 7 days (up to 10 to 14 days)
      2. Those without prior Hemodialysis respond rapidly to the initiation of Hemodialysis within 2 weeks
    3. Hemodialysis Associated Pericarditis
      1. Increased intensity and possibly the frequency and length of Hemodialysis
    4. Complications
      1. Hemorrhagic Tamponade (Anticoagulants used during Hemodialysis)
  2. Medications
    1. Low Dose Corticosteroids (e.g. Prednisone)
      1. Prednisone 0.25 to 0.5 mg/kg/day
    2. Intrapericardial infusion
      1. NSAIDs or Corticosteroids
    3. Avoid contraindicated medications
      1. Avoid Colchicine
      2. NSAIDs
        1. Should be used only with significant caution and in Consultation with nephrology
  3. Interventions
    1. Pericardiocentesis or pericardial window
      1. Indicated in Cardiac Tamponade
    2. Pericardiectomy
      1. Indicated in refractory constrictive Pericarditis

XII. References

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Related Studies

Ontology: Pericarditis secondary to uremia (C0265152)

Concepts Disease or Syndrome (T047)
SnomedCT 80119007
Italian Pericardite uremica
Dutch uremische pericarditis, pericarditis uremisch
German uraemische Perikarditis, Pericarditis uraemica
Japanese 尿毒症性心膜炎, ニョウドクショウセイシンマクエン
English uremic pericarditis (diagnosis), uremic pericarditis, Pericarditis uraemic, Pericarditis uremic, Pericarditis secondary to uremia, Uraemic pericarditis, Uremic pericarditis, Pericarditis secondary to uraemia, Pericarditis secondary to uremia (disorder)
Czech Perikarditida uremická, Uremická perikarditida
Hungarian Uraemiás pericarditis, Uraemiás szívburokgyulladás, Pericarditis uraemica
Spanish pericarditis secundaria a uremia (trastorno), pericarditis secundaria a uremia, pericarditis urémica, Pericarditis urémica
Portuguese Pericardite urémica
French Péricardite urémique

Ontology: Acute pericarditis - uremic (C0558914)

Concepts Disease or Syndrome (T047)
SnomedCT 194909006
English Acute pericarditis - uraemic, Acute pericarditis - uremic, Acute pericarditis - uremic (disorder)
Spanish pericarditis aguda - urémica (trastorno), pericarditis aguda - urémica

Ontology: chronic uremic pericarditis (C2074971)

Concepts Disease or Syndrome (T047)
English chronic uremic pericarditis (diagnosis), chronic uremic pericarditis