Clinical Scenario:
A 13-year-old boy with stage 5 chronic kidney disease presents with progressive shortness of breath and chest pain that is relieved by sitting forward. On examination, he has a pericardial friction rub. ECG shows diffuse ST-segment elevation. Echocardiography confirms a moderate pericardial effusion.
What is the most appropriate management?
A. Broad-spectrum antibiotics
B. Emergency dialysis
C. High-dose corticosteroids
D. Intravenous furosemide
E. Pericardiocentesis
Correct answer & Explanation:
Correct Answer: B. Emergency dialysis
Explanation
The child has uremic pericarditis, a life-threatening complication of advanced chronic kidney disease caused by accumulation of uremic toxins. The treatment of choice is urgent initiation or intensification of dialysis, which usually leads to resolution of pericarditis. Pericardiocentesis is reserved for patients who develop cardiac tamponade or have a large symptomatic effusion that does not respond to dialysis.
Learning Point:
Uremic pericarditis is an absolute indication for urgent dialysis in patients with advanced CKD.
