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Kidney Week

Abstract: PO2016

Impending Uremic Cardiac Tamponade in an Infant with ESKD

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Petri, Cassandra Ann, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Perez, Yalile, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cramer, Carl H., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Olson, Timothy M., Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hull, Nathan, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Hanna, Christian, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction

Uremic pericarditis (UP) occurs in patients with advanced chronic kidney disease (CKD) prior to dialysis initiation. The incidence of UP is rare due to advances in CKD management by providing adequate and early dialysis. Additionally, it is extremely rare in children. We present a case of a toddler with advanced CKD presenting with UP and impending cardiac tamponade. Daily intensive hemodialysis resulted in a complete resolution of the pericardial effusion.

Case Description

A 2-year-old female presented with a 3-day history of dry cough and low-grade fever. Her medical history was significant for CKD stage 5 related to branchio-oto-renal dysplasia. Her physical examination was remarkable for increased respiratory rate and the presence of pericardial friction rub. A chest radiograph demonstrated enlargement of the cardiac silhouette (Figure 1). An electrocardiogram (ECG) showed sinus rhythm without ST-segment changes and an echocardiogram demonstrated a large circumferential pericardial effusion. The following day, she developed low oxygen saturation and a repeat echocardiogram demonstrated features of early tamponade physiology. Pericardiocentesis was considered but not performed because the amount of apical fluid was deemed insufficient to safely perform the procedure. Daily intensive hemodialysis was initiated and resulted in a complete resolution of the pericardial effusion within a week.

Discussion

Our case of UP in a pediatric patient is exceptionally rare. The most common presentations of this condition are fever, chest pain, and pericardial friction rub. As seen in this case, a characteristic ECG in UP does not show the diffuse ST and T wave elevations often seen in other forms of pericarditis. UP is an absolute indication for dialysis which usually results in rapid resolution of the pericardial effusion.