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Uraemic Pericarditis — RACP Adult Medicine MCQ

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ModerateNephrologyUraemic PericarditisRACP Adult Medicine

A 60-year-old woman with chronic kidney disease stage 5 (eGFR 8 mL/min/1.73 m²) on haemodialysis develops intractable hiccups, pericardial friction rub, and asterixis. Her urea is 55 mmol/L. What is the most likely diagnosis?

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Correct answer: A — Uraemic pericarditis

Uraemic pericarditis occurs in patients with severe untreated or under-dialysed uraemia (typically urea >35–40 mmol/L). It presents with friction rub (which may be absent if effusion develops), chest pain, and other uraemic symptoms (asterixis, hiccups, nausea). ECG changes may be absent (unlike viral pericarditis). Treatment is intensified dialysis (daily for several days). Unlike other forms of pericarditis, anti-inflammatory agents are less effective. Pericardiocentesis is needed if tamponade develops.

Reference: KHA-CARI – 2013 – Cardiovascular Complications of CKD; eTG – 2025 – Nephrology