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Pericardectomy after pericarditis constrictiva led to onset of transplant kidney function after 98 days of anuric kidney graft: a case report.
BMC Nephrol. 2020 Jun 29; 21(1):241.BN

Abstract

BACKGROUND

Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and end-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was completely reversible after pericardectomy.

CASE PRESENTATION

A 43-year-old female caucasian patient received a living kidney donation from her mother. She had developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease after allogenic stem-cell transplantation for aplastic anemia. The graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery, but the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography showed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion profiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem on ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive acute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused by severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis, which could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been apparent on previous x-rays, computed tomography scans, or echocardiographies, including those for transplantation evaluation. Conservative management of the constrictive pericarditis was not successful and the graft remained anuric. Eventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the graft started urine production again, which significantly increased within a few days. The clearance improved and 2 weeks later, the patient was free from dialysis.

CONCLUSIONS

This case illustrates that special attention should be given to the pericardium during transplant evaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation.

Authors+Show Affiliations

Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany. caroline.wacker@uk-erlangen.de.Department of Cardiac Surgery, University Erlangen-Nürnberg, Krankenhausstraβe 12, 91054, Erlangen, Germany.Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.Department of Nephrology and Hypertension, University Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32600269

Citation

Wacker, Caroline, et al. "Pericardectomy After Pericarditis Constrictiva Led to Onset of Transplant Kidney Function After 98 Days of Anuric Kidney Graft: a Case Report." BMC Nephrology, vol. 21, no. 1, 2020, p. 241.
Wacker C, Weyand M, Schiffer M, et al. Pericardectomy after pericarditis constrictiva led to onset of transplant kidney function after 98 days of anuric kidney graft: a case report. BMC Nephrol. 2020;21(1):241.
Wacker, C., Weyand, M., Schiffer, M., & Opgenoorth, M. (2020). Pericardectomy after pericarditis constrictiva led to onset of transplant kidney function after 98 days of anuric kidney graft: a case report. BMC Nephrology, 21(1), 241. https://doi.org/10.1186/s12882-020-01899-2
Wacker C, et al. Pericardectomy After Pericarditis Constrictiva Led to Onset of Transplant Kidney Function After 98 Days of Anuric Kidney Graft: a Case Report. BMC Nephrol. 2020 Jun 29;21(1):241. PubMed PMID: 32600269.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pericardectomy after pericarditis constrictiva led to onset of transplant kidney function after 98 days of anuric kidney graft: a case report. AU - Wacker,Caroline, AU - Weyand,Michael, AU - Schiffer,Mario, AU - Opgenoorth,Mirian, Y1 - 2020/06/29/ PY - 2020/02/27/received PY - 2020/06/18/accepted PY - 2020/7/1/entrez PY - 2020/7/1/pubmed PY - 2020/7/1/medline KW - Case report KW - Constrictive pericarditis KW - Delayed graft function KW - Kidney transplant KW - Pericardectomy SP - 241 EP - 241 JF - BMC nephrology JO - BMC Nephrol VL - 21 IS - 1 N2 - BACKGROUND: Constrictive pericarditis is easily overlooked and can lead to severe problems in hemodynamics and end-organ perfusion, in our patient leading to 98 days of anuria after living kidney transplantation. This was completely reversible after pericardectomy. CASE PRESENTATION: A 43-year-old female caucasian patient received a living kidney donation from her mother. She had developed end-stage renal disease 2 years prior due to nephrotic syndrome linked to graft-versus-host disease after allogenic stem-cell transplantation for aplastic anemia. The graft showed insufficient function already in the early postoperative phase. Dialysis was paused after surgery, but the patient developed hypervolemia with ascites and edema in the lower extremities. Doppler ultrasonography showed scarce perfusion, with intrarenal arterial waveforms without end-diastolic flow. The venous perfusion profiles showed pulsatile retrograde flow. There was no identifiable reason for a primary vascular perfusion problem on ultrasonography or transplant kidney angiography. Kidney transplant biopsy revealed no rejection but extensive acute tubular necrosis. Three weeks after transplantation, the patient developed an acute anuric graft failure caused by severe cardiac decompensation. Echocardiography revealed a previously unnoticed constrictive pericarditis, which could be confirmed in a cardio computed tomography scan. The constrictive pericarditis had not been apparent on previous x-rays, computed tomography scans, or echocardiographies, including those for transplantation evaluation. Conservative management of the constrictive pericarditis was not successful and the graft remained anuric. Eventually, the patient underwent pericardectomy 16 weeks after kidney transplantation. Shortly after surgery, the graft started urine production again, which significantly increased within a few days. The clearance improved and 2 weeks later, the patient was free from dialysis. CONCLUSIONS: This case illustrates that special attention should be given to the pericardium during transplant evaluation, especially for patients who previously underwent stem-cell transplantations, chemotherapy or radiation. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/32600269/Pericardectomy_after_pericarditis_constrictiva_led_to_onset_of_transplant_kidney_function_after_98 days_of_anuric_kidney_graft:_a_case_report L2 - https://www.biomedcentral.com/1471-2369/21/241 DB - PRIME DP - Unbound Medicine ER -
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