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Uraemic pericarditis — RACP Adult Medicine MCQ

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HardCardiologyUraemic pericarditisRACP Adult Medicine

A patient with advanced kidney failure has pleuritic chest pain, a pericardial rub and a small non-tamponading effusion with no alternative cause. Urea is 38 mmol/L. What is the principal treatment?

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Correct answer: B — Initiate or intensify dialysis urgently with close echocardiographic and haemodynamic monitoring

The best answer is “Initiate or intensify dialysis urgently with close echocardiographic and haemodynamic monitoring”. Uraemic pericarditis is an indication for urgent dialysis initiation or intensification. Tamponade, a large progressive effusion or failure to improve can require drainage; a small stable effusion does not automatically. NSAIDs add kidney and bleeding toxicity and do not remove uraemic solutes, while the diffuse inflammatory ECG pattern is not an indication for thrombolysis.

Reference: Queensland Health: Chronic kidney disease emergency criteria: https://www.health.qld.gov.au/cpc/kidney-medicinenephrology/chronic-kidney-disease Kidney Health Australia: CKD Management in Primary Care, 5th edition: https://kidney.org.au/health-professionals/ckd-management-handbook/