Ankara Üniversitesi Tıp Fakültesi Mecmuası

0365-8104 1307-5608

Ankara University

Internal Diseases

İç Hastalıkları

Uremic Pericarditis and Long-Term Chronic Hemodialysis Treatment

Üremik Perikarditler ve Uzun Süreli Kronik Hemodializ Tedavisi

Ertuğ

A.ergün

ANKARA UNIVERSITY, ANKARA FACULTY OF MEDICINE

12 31 1976

29 4 907 926 10 01 1976 12 31 1976

1947

Ankara Üniversitesi Tıp Fakültesi Mecmuası

Üremik Perikarditler ve Uzun Süreli Hemodializ Tedavisiİç Hastalıkları Kliniğinde Temmuz - 1975 ve Ocak - 1977 tarihleri arasında 27 kronik böbrek yetmezlikli vakaya kronikhemodializ tedavisi uygulanmıştır. Bunlardan 6 tanesi perikarditli olup, perikardit vakalarından ikisi dializ tedavisine başlandıktan sonra (5 ay ve 14 ay) oluşmuştur. Üç vakada tamponetortaya çıkmıştır. Bu vakalarda bölgesel heparinizasyonlu hemodializ, perikardiosentez, ve İndomethacin tedavisi uygulanmıştır. Üç vakada perikardit tamamen gerilemiş, bir vakadakronik konstriktif perikardit oluşmuş, diğer iki vaka ise kısa bir süre içinde ölmüşlerdir.Etyopatogenezleri bugün için açık olmayan üremik perikarditler bazı non - spesifik yöntemler ile tedavi edilebilmektedirler. Bu tedavi, aşağıda ki şekilde sıralanabilir :1 — Bölgesel heparinizasyon ile sık ve yoğun hemodializ,2 — Durumda düzelme olmamış ve akut kalb tamponadıbulguları yok ise İndomethacin, tamponat var ise perikardiosentezden sonra İndomethacin verilir.3 — Yine düzelme olmazsa, perikard içine, emilime uğramayan steroidlerin verilmesi gerekir,4 — Bunlar yeterli olmuşorsa cerrahi tedavi ve tercihan.parsiel perikardiektomiye gidilmelidir.

Uremic Pericarditis and Long-Term Hemodialysis TreatmentChronic hemodialysis treatment was applied to 27 chronic renal failure cases in the Internal Medicine Clinic between July - 1975 and January - 1977. Six of them had pericarditis, and two of the pericarditis cases occurred after the dialysis treatment was started (5 months and 14 months). Tamponade occurred in three cases. Regional heparinized hemodialysis, pericardiocentesis, and Indomethacin treatment were applied in these cases. Pericarditis completely regressed in three cases, chronic constrictive pericarditis occurred in one case, and the other two cases died in a short time.Uremic pericarditis, the etiopathogenesis of which is not clear today, can be treated with some non-specific methods.This treatment can be listed as follows:1 — Frequent and intensive hemodialysis with regional heparinization,2 — If there is no improvement in the condition and there are no signs of acute cardiac tamponade, Indomethacin is given, if there is tamponade, Indomethacin is given after pericardiocentesis.3 — If there is still no improvement, non-absorbable steroids should be given into the pericardium,4 — If these are sufficient, surgical treatment and preferably partial pericardiectomy should be performed.

perikardit tedavi hemodiyaliz

perikardit hemodiyaliz tedavi

1 — ALFREY, A.C; GOSS,J.E, OGDEN, D.A; VOGEL, H.K.and HOLMES, J.H.: Uremic hemopericardium. Am. J. Med?, 45: 391-400, 1968.

2 — BAİLEY, G.L; HAMPERS, C.L; and HAGER, E.B. Uremic pericarditis.Clinical features and managemeni. Circulation 38; 582-591, 1968.

3 — BAİLEY, G.L.: Hemodialysis. Academic Press, New york and London,1972.

4 — BEFSON, P.B; McDERMOTT, W. Textbook of Medicine, W.B. Saunders Company, Philadelphia, London Toronto, Fourth ed.,197 5.

5 — BEAUDRY, C: NAKAMOTOS, S.; KOLFF, W. J.: Uremic pericarditis and cardiac tamponade in chronic renal failure. Ann Intern Med 64: 990-995, 1966. ,

6 — BUSELMEİER, TJ,; SİMMONS, R.L; NAJARIAN, J.S; MAUER, S.M;MATAS, AJJ., and KJELİSTRAND, C. M. Uremic Pericardial Effusion.Nephron 16, 5:371-379, 1976. N

7 — CLARKSON, B. A.: Uric acid related to uremiç symptoms, Proc Eur Dial Transpl Assoc 3:3-8, 1966. i

8 — COMPTY, C.M; CAHEN, G.L; and SHARPIRO, FL. Pericarditis and its seguels. Annintern Med 75: 173-183, 1971. :

9 — FNEDRİKSEN, R.T; COHEN, L.S. and MULLINS, C.B. Pericardial windows or pericardiocentesis for pericardial eftusions. Am Heart J82: 158-162, 1971. '

10 — FULLER, J.T; KNOCHEL, P.J; BRENNAN, J.P; FETNER, D.C; WHİTE, G.M.: Reversal of Intraçtable Uremic Pericarditis by Triamcinolone Hexactonide. Arch Intern Med 136, 979-982, 1976. i

11 — GHAVAMİAN, M,; GUTCH, C.F. HUGHES, R.K., KOPP, K.F. and KOLFF, W.J: Pericardial Tamponade in Chronic-Hemodiolysis Patients. Treated by Pericardiectomy. Arc Intern Med 131: 249 - 253, 1978.

12 — HAGER, E.B. Clinical Observation of Five Patients with Uremic Pericardial tamponade N Engi JMed 273: 304-308, 1965.

13 — HUGH, H. Hussey: Pericarditis During Long-term Hemodialysis JAMA 232, II 1156, June, 1975,

14 — LAZARUS, J.M. and co. Cardiovascular disease in Uremic Patienison . Hemodialysis Kidney int (Suppl) 2: 167, Jan, 1975

15 — MARİNI VERGNE PEDRO and HULL R. ALAN: Uremic Pericarditison Kidney İnt (Suppl) 2: 163-6, Jan, 1975 '

16 — MİNUTH,AA .N; NOTTEBOHM, A.G; EKNOYAN, G; SUKİ, NW. İndomethacin Treatment of Pericarditis in Chronic Hemodiaysis Patienis; Arch İntern Med 135:807-811, 1975.

17 — MİTCHELL, A.G. Pericarditis During Chronic Hemodiolysis Therapy. Postgrad. Med J 50/590: 741-745, 1974.

18 — SİNGH, and co. Pericardiectomy in uremia: The Treatment of Choice for Cardiac Tamponade in Chronic Renal Failure: JAMA 228, 9: 1123, 1974.

19 — SYMONS, H.S; WRONG, O.M. Üremic Pericarditis with Câardiac Tamponade: A report of four cases Br Med J 1: 605-606, 1964.

20 — TRAİGER, M.J; GONİNA, DeLaHaye, J.P; FRANÇOİS, B; PLAUCHU, G; FROMENT, A.: Pericarditis Uremigue â Evolution Constricture Subaigue Lyon Med 211: 383-401, 1964.