Pericardial disease in renal patients.

Pericardial disease is common in patients with renal disease. Approximately 20% of uremic patients requiring chronic dialysis develop uremic pericarditis or dialysis pericarditis. In all forms of uremic pericarditis, cardiac tamponade is the main danger.

Diagnostic value of adenosine deaminase activity in pericardial fluids.

Background: The activity of adenosine deaminase (ADA) was determined in serum and pericardial fluid of 70 patients (ages 21 to 71 years) with pericardial effusions of various etiologies and in 15 control subjects.

Methods: The patients were subdivided into five groups on the basis of definite diagnosis: 1) 24 patients with tuberculosis; 2) 22 with malignancies; 3) 12 with uremic pericarditis; 4) 12 with purulent pericarditis; 5) 15 control individuals without pericardial disease. The activity of ADA was determined at the same time in serum and cell-free pericardial fluid according to the method of Karker with minor modification.

Percutaneous pericardial biopsy: technique, efficacy, safety, and value in the management of pericardial effusion in children and adolescents.

This study describes our technique of nonsurgical percutaneous pericardial biopsy (PPB), its efficacy and safety, and its diagnostic and therapeutic usefulness in the management of pericardial effusion (PE) in children and adolescents. In an 8-year period, 19 selected patients, aged 2 to 20 years, had PPB for evaluation and treatment of PE. Using this procedure we procured multiple biopsy specimens from various areas of the thickened parietal pericardium, and also procured pericardial fluid for investigation.

Pericardial involvement in systemic sclerosis.

Objective: To determine the frequency and histological characteristics of pericardial involvement in systemic sclerosis.

Method: Necropsy sections of pericardium from 44 patients with systemic sclerosis were studied, together with sections from 19 age/sex matched controls. Sections were stained with haematoxylin and eosin, acid toluidine blue, and elastic van Gieson.

Thoracic complications in uremic patients and in patients undergoing dialytic treatment: state of the art.

No organ in the chest is spared the negative effects of uremia. The dialytic treatment itself is often associated with a large array of thoracic complications. We review the main thoracic manifestations of the terminal uremia from the radiological point of view, such as: uremic pleuritis and pericarditis, uremic pneumonia, renal osteodystrophy, infections, and metastatic pulmonary calcifications.

[Acute uremic pericarditis presented as cardiac tamponade with acute ischemic hepatitis: a case report].

Pericarditis is a frequent and serious complication of chronic uremia. The uremic pericarditis can get much improvement by aggressive heparin-free hemodialysis therapy. However, the presenting symptoms and signs are too nonspecific to identify at early stage.

The bleeding risk in chronic haemodialysis: preventive strategies in high-risk patients.

Haemodialysis (HD) patients are at an increased risk of bleeding because of uraemic bleeding tendency and systemic anticoagulation caused by intermittent heparinization. Additional risk factors may be aspirin or coumarin use for the prevention of fistula thrombosis, diffuse intravascular coagulation, recent trauma, postsurgical state, inadequate control of hypertension, gastrointestinal lesions, diabetic retinopathy, renal cystic disease, and uraemic pericarditis. In HD patients with an active bleeding focus blood transfusion, desmopressin acetate (DDAVP), conjugated oestrogens, and dialysis treatment can limit the bleeding risk.

Left ventricular morphology and diastolic function in uraemia: echocardiographic evidence of a specific cardiomyopathy.

Objective: To see whether cardiac morphological and functional abnormalities in uraemic patients are determined by high blood pressure or if they are an expression of a specific cardiomyopathy.

Design: Cross sectional study.

Setting: City general hospital in Italy.

The efficacy of indomethacin in the treatment of uremic pericarditis.

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.

[Hemodynamic disorders and their correction in peritoneal dialysis of children with acute renal failure].

Hemodynamic disorders occurring during acute renal failure (ARF) in children with the hemolytic uremic syndrome and the effects of peritoneal dialysis on hemodynamics were studied. A complex of electrophysiological methods was used: Integral whole body rheography, electrocardiography, and polycardiography, which permitted assessment of the severity and type of hemodynamic disorders in ARF. Three main types of hemodynamic changes were observed: hypodynamic, hyperdynamic, and normodynamic.

[Pericardiectomy: a challenge, a reality. The surgical experience of the Instituto Nacional de Cardiología "Ignacio Chávez"].

The surgical aspect of the pericardial disease has grown in the last years due to new diagnostic, surgical and anesthetic procedures. We reviewed 20 patients, who underwent pericardiectomy in the National Institute of Cardiology "Ignacio Chávez" between august 1987 and september 1992. Nine males and eleven females whose age ranged from 18 years to 57 years with a mean of 35.

Uremic pericarditis in chronic renal failure: nursing implications.

Cardiovascular complications are the leading cause of death in patients with chronic renal failure. Pericardial disease is among the first recognized manifestations of uremia. This article explores the pathophysiology of uremic pericarditis, assessment of chronic renal failure patients at risk for developing pericarditis, and major complications of pericarditis.

Haemolytic uraemic syndrome and renal dysfunction following BEAC (BCNU, etoposide, ara-C, cyclophosphamide) +/- TBI and autologous BMT for malignant lymphomas.

Twenty-four patients autografted for malignant lymphoma have been followed. All were conditioned with BEAC (BCNU, etoposide, ara-C, cyclophosphamide), in 10 patients combined with total body irradiation (TBI) 7.5 Gy.

Cytomegalovirus disease in a renal transplant recipient manifesting with pericarditis.

A 12-year-old uraemic patient who had received a renal allograft from a donor of unknown cytomegalovirus (CMV) serology was evaluated for subfebrile fever and pericardial effusion. Viral DNA was detected with PCR. The patient responded very well to Ganciclovir therapy.

[Arteriovenous hemofiltration as an adjuvant therapy in peritoneal dialysis and hemodialysis in a patient with terminal renal failure].

In the uraemic patient regularly treated with peritoneal dialyses occurring peritonitis caused a decrease of ultrafiltration and transfer abilities of the peritoneum. Other symptoms dangerous for life also appeared: uraemic pericarditis and significant overhydration. Peritoneal dialyses lost its effectiveness.

[Pericardioscopy--a new window to the heart in inflammatory heart diseases].

Pericardioscopy is a new diagnostic tool to visualize macroscopically alterations of both the epicardium and pericardium. For the first time the macropathology of the epicarditis and pericarditis can be observed in vivo by the cardiologist in viral, bacterial, uremic and autoimmune cardiac processes. It enables us also to get an insight into neoplastic and metastatic processes affecting the heart and the pericardium.

[The heart in chronic kidney failure patients].

Risk factors for heart disease in patients with chronic renal failure (CRF) are the same as in general population; moreover CRF and renal replacement therapies (dialysis, immunosuppressive drugs for kidney transplantation) induce further specific cardiac risks. In practice, the commonest heart diseases associated with CRF are coronary artery diseases, myocardiopathies from various aetiologies, valve diseases and arrhythmias. Uremic pericarditis are quite unusual nowadays.

Pericarditis following renal transplantation.

We analyzed data on renal allograft recipients over a 27-year period in order to investigate the frequency, etiology, and outcome of pericarditis developing during the first two months following renal transplantation. Of the 1497 patients receiving renal transplants between 1963 and 1990, 34 patients developed 36 episodes of pericarditis and/or pericardial effusions, for an overall incidence of 2.4%.

[Pathological processes with accumulation of fluid in the pericardial sac].

Fluid in the pericardial sac may accumulate due to transudate, inflammatory process in the pericardium, shunting of blood from the ventricles or large vessels into the pericardial cavity. The presence and amount of fluid is best evaluated by using echocardiography. Pathological fluid in the pericardial sac does not cause major hemodynamic disorders until the intrapericardial pressure is normal.

Pericarditis in end-stage renal disease.

Our approach to the clinical management of uremic and dialysis-associated pericarditis has been presented previously and is outlined in Figure 1. In hemodynamically stable patients with no effusion and in those with small to medium effusions, we recommend initial therapy with intensified dialysis. Close monitoring, perhaps every third day, with echocardiography should be carried out.