Korean Journal of Nephrology 1992;11(4):400-405.

만성 신부전 환자에서의 심낭염과 심낭 삼출에 관한 임상적 고찰

김홍수 , 최규헌 , 하성규 , 이호영 , 한대석 , 김문재

Abstract

Thirty-six chronic renal failure patients who had findings compatible to pericarditis such as pericardial friction rub, chest pain, high fever or who had pericar- dial effusion on echocardiography which was performed due to cardiomegaly were divided into uremic pericar- ditis and dialysis associated pericarditis according to the duration of dialysis. Pericarditis developed before the dialysis or less than 8 weeks of dialysis was defined as uremic pericarditis and pericarditis developed after than 8 weeks of dialysis was defined as dialysis associat- ed pericarditis. We evaluated sex, age, incidence of diabetes mellitus, dialysis duration, blood pressure, blood chemistry, pericardial effusion amount, the incidence of cardiac tamponade, treatment modality in both type of pericarditis. 1) Among 36 patients uremic pericarditis were 21 (58. 3%) cases and dialysis associated pericardits 15 (41. 7%) cases. Cardiac tamponade were founded in 2 (9.5%) and 3(20%) cases each. 2) The sex ratio in uremic and dialysis associated pericarditis were 17:4 and 10:5, the mean age 42,9 and 46. 9 years. Diabetes mellitus were in 4 (19.1%) and 5(33. 3%) cases and the mean dialysis duration until the pericarditis revealed were 27.0 and 710.3 days each. 3) BUN, creatinine, total protein, albumin, hemoglo- bin, hematocrit level didnt show any statistical differ- ences between the uremic and dialysis associated per- icarditis. 4) The echocardiographic findings of the uremic per- icarditis at the time of the diagnosis revealed small amount 9 (42.9%), moderate 8 (38.1%), large 4 (19.0%) cases each. The findings of dialysis associated pericar- ditis were small amount 7 (46.7%), moderate 6 (40,0%), large 2 (13.3%) cases which showed no statistical differ- ences with the amount of pericardial effusion of uremc pericarditis. 5) The treatment of uremic pericarditis were medical 18 (85.7%) cases and surgical 3 (14.3%) cases and the dialysis associated pericarditis were 11 (73,3%) and 4 (26.7%) case each. In conclusion, the dialysis associated pericarditis which developed more cardiac tamponade and needed more surgical treatment than the uremic pericarditis seems to have poor prognosis than the uremic pericar- ditis, but for better analysis of prognosis and path- ogenesis prospective study with large group of patients are required.