Uremic pericarditis in a not-so-terminal chronic kidney disease

A 90-year-old patient with chronic kidney disease (stage G4) was diagnosed with pneumonia and congestive heart failure. Despite treatment with levofloxacin and furosemide, his condition deteriorated. A CT scan of the chest revealed pericardial effusion, leading to the suspicion of uremic pericarditis. Daily hemodialysis was started, resulting in significant clinical and biological improvement. Uremic pericarditis due to accumulation of uremic toxins resulting in pericardial effusion is common in end-stage renal disease. Diagnosis is guided by clinical and paraclinical findings and a high index of suspicion. Early recognition and treatment remain critical to prevent complications even in pre-end stage renal disease.