What are the other Names for this Condition? (Also known as/Synonyms)

• Fibrinous Pericarditis
• Uremic Pericardial Inflammation

What is Uremic Pericarditis? (Definition/Background Information)

• Pericarditis refers to swelling and inflammation of the pericardium, a sac-like layer that covers the heart. The pericardium contains a fluid that keeps the heart muscle moist and ensures a smooth function
• Generally, this sac becomes inflamed due to an underlying condition that results in friction between the membrane and muscle causes a stabbing chest pain, thereby leading to pericarditis
• Uremic Pericarditis is the result of increased blood urea nitrogen (BUN) levels in the body, which may be caused by conditions such as kidney failure, heart attack, severe dehydration, and many other factors
• The treatment of Uremic Pericarditis primarily involves treating the underlying cause of high BUN levels. The prognosis depends on many factors, such as the severity of the underlying condition; although in most cases with appropriate treatment, it is good

Who gets Uremic Pericarditis? (Age and Sex Distribution)

• Uremic Pericarditis is a rare type of pericarditis that occurs due to increased BUN levels. Individuals of any age may be at risk for the condition
• Both males and females may be affected
• No racial, ethnic, or geographical preferences are seen

What are the Risk Factors for Uremic Pericarditis? (Predisposing Factors)

Any medical condition that results in increased blood urea nitrogen (BUN) levels in the body can be considered as a risk factor for Uremic Pericarditis, and these include the following:

• Acute kidney failure that may occur due to a variety of reasons
• Severe urinary tract infection
• Post heart attack; if the kidney function is affected in a significant manner
• Polycystic kidney disease
• Kidney stones
• Severe dehydration
• Enlarged prostate gland
• Tumors of the kidney and prostate
• Severe burns
• A previous diagnosis of acute pericarditis may increase the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Uremic Pericarditis? (Etiology)

The exact cause of Uremic Pericarditis is unknown.

• However, it occurs when the blood urea nitrogen levels in the body exceed 60 mg/dL (normal levels are between 7-20 mg/dL)
• Increased BUN levels may occur as a result of the following conditions:
  • Conditions affecting the kidney such as acute renal failure, kidney stones, tumors, and polycystic kidney disease
  • Conditions affecting the prostate or urinary tract
  • Heart attack
  • Severe dehydration, burns

Pericarditis, in general, may also occur due to infectious pathogens such as a virus, bacteria, or fungus; although, in a majority of cases, the cause of pericarditis remains unidentified (idiopathic pericarditis).

What are the Signs and Symptoms of Uremic Pericarditis?

The signs and symptoms of Uremic Pericarditis include, but are not limited to, the following:

• Low-grade fever, chills, sweating
• Chest pain; pain in chest increases on coughing or swallowing
• Dry cough
• Fatigue, anxiety
• Difficulty breathing, which gets worse especially while reclining or lying down, but gets better on sitting, leaning forward or standing
• Rapid heart rate, heart palpitations
• Pain in the back
• Swelling of the legs and feet (edema)
• Signs and symptoms of the underlying condition or disorder

How is Uremic Pericarditis Diagnosed?

A diagnosis of Uremic Pericarditis may be made as follows:

• A thorough physical examination with a complete medical history
• If symptoms are noted, the healthcare provider may need a full medical history to correlate the condition and rule out other possible causes of infection
• A stethoscope is used to listen to the heartbeat; if a faint sound is heard, it can usually raise suspicion/concern for the healthcare provider

A series of tests to view structures and fluid present in the heart may then be ordered, for further observation of the condition. These tests may include:

• Blood urea nitrogen level test
• Blood test to determine underlying disorder
• Blood culture to determine the causative organism, if bacterial or fungal infection is suspected
• X-ray of chest
• CT or MRI scan of the chest
• Echocardiogram

The radiology imaging tests may show the presence of any abnormal fluid levels around the heart, within the pericardial sac.

• Sometimes, depending on the clinical situation, abnormal fluid in the pericardial sac may be cultured, to determine if there is an infectious cause
• The fluid is collected by aspiration through a procedure called pericardiocentisis

Note: If a tissue biopsy of the pericardium is performed, then significant inflammation of the pericardium may not be generally observed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Uremic Pericarditis?

The following complications may occur due to Uremic Pericarditis:

• Constrictive pericarditis, a condition wherein the heart function is restricted, due to compression by the surrounding pericardial sac
• Swelling of the lungs (pulmonary edema)
• Cardiac tamponade (accumulation of excess fluid)
• Shock: A condition which can result in failure of vital organs in the body
• Complications that arise from the underlying condition or disorder
• The condition may recur (recurrent pericarditis) or last for many years (chronic pericarditis)

How is Uremic Pericarditis Treated?

The underlying condition must be treated, in order to effectively control and cure pericarditis. This may include steps to bring down the BUN score to near normal levels. The treatment of Uremic Pericarditis may include the following measures:

• Dialysis to bring down the blood urea nitrogen levels
• The use of medications to manage pain such as:
  • Analgesics (to relieve pain)
  • Anti-inflammatory medication (to decrease inflammation)
• Plenty of rest (bed rest) will be recommended as well
• If there is a severe buildup of fluid, a small cut is made in the pericardium, to allow drainage of the fluid. This procedure is called pericardiocentesis
• Additionally, diuretics to help decrease excess fluid accumulation in the body, may be administered
• The treatment for recurrent pericarditis (arising from acute pericarditis) is using colchicine medication

How can Uremic Pericarditis be Prevented?

A few preventative tips for Uremic Pericarditis may include:

• Undertaking proper and effective treatment of underlying conditions, especially conditions that affect the kidney
• Maintaining a healthy lifestyle and diet

What is the Prognosis of Uremic Pericarditis? (Outcomes/Resolutions)

• Uremic Pericarditis can lead to life-threatening symptoms, if the condition is left untreated. The prognosis depends on the severity of the signs and symptoms of the underlying condition
• If the condition is diagnosed early and treated effectively, the affected individuals typically make a full recovery

Additional and Relevant Useful Information for Uremic Pericarditis:

The following DoveMed website link is a useful resource for additional information:

http://www.dovemed.com/common-procedures/procedures-laboratory/pericardial-fluid-analysis/