Uremic pericarditis.

Abstract

Abstract The frequency of uremic pericarditis and complicating cardiac tamponade has been determined in a series of 125 patients in terminal uremia. Forty (32%) were found to have uremic pericarditis, and five of these patients (12.5%) developed a pericardial effusion sufficient to produce cardiac tamponade. The diagnosis uremic pericarditis had been made during life in 32 of the 40 patients on the presence of a pericardial friction rub, which was found to be the most constant symptom of pericarditis. Demonstration of acute pericardial constriction was solely clinical: rapidly developing cardiac insufficiency in a clinical situation where hypertensive heart disease, overhydration and severe anemia could be ruled out as etiologic factors.Seven of the patients with uremic pericarditis were treated with regular hemodialysis using universal heparinization. One patient developed cardiac tamponade in connection with his first hemodialysis. All the rest of the hemodialyses in this patient and in the other patients were without complications. The risk of universal heparinization must therefore be considered to be minimal. The size and shape of the heart became normal in three of the seven patients and the pericardial friction rub disappeared in all of them during intermittent hemodialysis. It is thus possible with effective hemodialysis to treat uremic pericarditis and complicating pericardial effusion so that renal allotransplantation can be carried out. Eight patients with uremic pericarditis in this series, including two with cardiac tamponade, have received renal transplants. Seven of these patients are alive, one three years post‐transplant.