Acute pericardial effusion and renal failure: etiologic diagnosis and outcome
© BioMed Central Ltd 2001
Published: 1 March 1997
To assess the etiologic diagnosis and outcome of acute pericardial effusion (PE) associated to acute renal failure (ARF) or end-stage renal disease (ESRD).
Retrospective study from 1978 to 1996.
A 10-bed medical/surgical ICU.
The charts of 17 patients having acute PE and renal failure at ICU admission were reviewed. Diagnosis and severity of PE were echocardiographically defined in all patients. Moderate PE corresponded to no right heart chambers compression (RHCC); severe PE to RHCC without hypotension; and cardiac tamponade to RHCC with hypotension. ARF was defined as follows: in patients without pre-existing renal disease by a serum creatinine value ≥ 150 μmol/l; in patients with previous renal insufficiency by an increase in serum creatinine of ≥ 100% above baseline values. ESRD was defined by chronic hemodialysis requirement.
Measurements and results
Eleven patients had ARF and six ESRD. In ARF group and in ESRD group, mean age was 57.7 and 52.2 years, mean SAPS II was 43.3 and 52.8, number of patients requiring mechanical ventilation was four and two, and number of ICU deaths was four and three respectively. In ARF and in ESRD group, moderate PE was noted in two and one cases, severe PE in three and three cases, cardiac tamponade in six and two cases, and pericardial window was performed in two and four cases respectively. In ARF group 7 patients required dialysis, that was transient in survival patients. PE etiological diagnosis was systemic lupus with extra-capillary glomerulonephritis (n = 2), systemic fibrosis with obstructive renal failure (n = 2), anticoagulation accident with hemodynamic renal failure (n = 2), lung adenocarcinoma (n = 2), adenocarcinoma of undetermined origin (n = 1), systemic polyarteritis nodosa (n = 1), and Wegener granulomatosis (n = 1). In ESRD group, PE etiological diagnosis was uremic pericarditis (n = 5), and prostatic cancer (n = 1).
Despite malignancy being claimed as the leading cause of cardiac tamponade, when associated to ARF other etiologic diagnoses must be evoked that prompt specific treatment and could prevent unfavorable evolution. In ESRD patients admitted to ICU, uremia emerged as the most common etiology of PE, and mortality rate is high. These patients should undergo pericardial window to favorise pericardial symphysis, and prevent recidive.