The efficacy of indomethacin in the treatment of uremic pericarditis.

Abstract

Uremic pericarditis is common in patients undergoing chronic hemodialysis and has been difficult to cure using conservative medical and surgical methods of treatment. Indomethacin therapy for uremic pericarditis has been reported infrequently. We present a case of uremic pericarditis in which indomethacin was particularly effective. The patient was a 45-year-old woman with thrombocytopenia due to Banti's syndrome and congestive heart failure with pericardial effusion. She had been undergoing hemodialysis for 3 years for chronic renal failure due to chronic glomerulonephritis. Uremic pericarditis was diagnosed based on serological laboratory results, aspirated pericardial fluid, and an echocardiogram. She was treated with oral doses of 25 mg t.i.d. indomethacin in addition to hemodialysis and extracorporeal ultrafiltration method. Pericardial effusion and left ventricular dysfunction disappeared after indomethacin therapy for 38 days. There are conflicting reports on the efficacy of indomethacin therapy in patients with uremic pericarditis. While indomethacin therapy was very effective in our case, there may be many causes of uremic pericarditis for which indomethacin may not be efficacious. Further investigations of indomethacin therapy for patients with uremic pericarditis are necessary to elucidate the therapeutic mechanism by which indomethacin acts.