B4.070 Prework 1: Uremic Pericarditis

Question 1

normal function of kidneys

Answer 1

maintained fluid balance
maintain acid base balance
maintain electrolyte balance (K, Na)
excrete byproducts of metabolism
hormone secretion
undefined functions

Question 2

what is uremia

Answer 2

urine in the blood
clinical syndrome that develops when kidneys fail and are unable to remove toxic wastes from the body
GFR < 10 ml

Question 3

metabolic abnormalities with renal failure

Answer 3

acidosis
hyperkalemia
endocrine abnormalities
anemia
coagulopathy
increased ROS and inflammation

Question 4

early clinical features of uremia

Answer 4

fatigue, malaise
nausea, vomiting
loss of appetite
fluid retention

Question 5

later clinical features of uremia

Answer 5

mental status changes 
seizures
cardiac arrhythmias
pericardial problems 
death

Question 6

effect of low albumin on pericardium

Answer 6

low oncotic pressure

transudative effusion

Question 7

effect of anemia on pericardium

Answer 7

heart failure

Question 8

effect of coagulopathy on pericardium

Answer 8

repeated bleeding into pericardium

Question 9

effect of inflammation on pericardium

Answer 9

excess ROS
accumulation of toxic metabolites
hormonal imbalance

Question 10

types of pericardial involvement in uremia

Answer 10

simple pericardial effusion
complex (loculated) effusion
tamponade
constriction

Question 11

classification of uremic pericarditis

Answer 11

never been on dialysis

been on dialysis < 8 weeks

Question 12

dialysis pericarditis

Answer 12

develops on patients who are on dialysis

Question 13

etiology of uremic pericarditis

Answer 13

due to uremia associated metabolic derangements
inadequate dialysis
usually respond to aggressive dialysis

Question 14

incidence/prevalence of uremic pericarditis

Answer 14

difficult to be sure as many are asymptomatic
much less now in the days of organized dialysis centers
2-20%
constriction: 4-12% of those w uremic pericarditis

Question 15

how to diagnose uremic pericarditis

Answer 15

rule out underlying etiologies:
-cancer
-auto immune disorders
-infections
may need diagnostic pericardial tap

Question 16

transudate

Answer 16

increased hydrostatic pressure or decreased albumin in capillary
fluid leakage only

Question 17

exudate

Answer 17

fluid and protein leakage

inflammatory driven

Question 18

transudate fluid characteristics

Answer 18

< 3 g/ dl protein
<200 IU/L LDH
<1.015 spec grav
>7.2 pH
no clotting
<300 WBC count
glucose = serum glucose

Question 19

exudate fluid characteristics

Answer 19

> 3 g/ dl protein
>200 IU/L LDH
>1.015 spec grav
<7.2 pH
clotting present
>500 WBC count
<60 glucose

Question 20

etiology of transudates

Answer 20

liver cirrhosis
CHF
nephrotic syndrome

Question 21

etiology of exudates

Answer 21

infection
neoplasm
trauma
uremia

Question 22

management of uremic pericarditis with asymptomatic effusions

Answer 22

intensive dialysis

recheck in couple of weeks

Question 23

management of acute uremic pericarditis

Answer 23

intensive dialysis
NSAIDs
colchicine is contraindicated

Question 24

management of uremic pericarditis with large effusion

Answer 24

most respond to intensive dialysis
most have resolution/ decrease in 2 weeks
be careful when you remove blood for dialysis they can get hypotensive

Question 25

management of uremic pericarditis with tamponade

Answer 25

most will not tolerate dialysis
place pericardial drain and then dialysis
surgical pericardial window if loculated