Uremic pleuritis in a patient on maintenance hemodialysis who showed refractory pleural effusion: autopsy results

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  • 原因不明の胸水貯留を繰り返し，剖検にて尿毒症性胸膜炎と診断し得た維持透析患者の１例
  • 症例報告 原因不明の胸水貯留を繰り返し,剖検にて尿毒症性胸膜炎と診断し得た維持透析患者の1例
  • ショウレイ ホウコク ゲンイン フメイ ノ キョウスイ チョリュウ オ クリカエシ ボウケン ニテ ニョウドクショウセイ キョウマクエン ト シンダン シエタ イジ トウセキ カンジャ ノ 1レイ

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A 78-year-old man who had been receiving hemodialysis (HD) for 2 years was admitted to our hospital due to right-sided pleural effusion that had been nonresponsive to HD. The pleural effusion was hemorrhagic and exudative ; however, various examinations could not demonstrate the specific cause of pleural effusion. Despite the administration of antibiotics and antituberculosis drugs as an empirical therapy, pleural effusion persisted. When left pleural effusion also developed, we performed pleural biopsy under CT-guidance and video-assisted thoracoscopy. The biopsy sample demonstrated nonspecific pleuritis without any finding of infectious disease or malignancy. The patient died of respiratory failure in November 2007, and was autopsied. The findings at autopsy demonstrated pleural fibrosis and pleuritis. Then he was finally diagnosed as having uremic pleuritis on the basis of the clinical and pathological features. There may be relatively many cases of uremic pleuritis among patients on maintenance HD. However, such cases may often be overlooked. It was interesting to note in the present case that no specific cause such as infectious diseases or malignancy were detected even after autopsy. Therefore uremic pleuritis should be taken into consideration as a likely candidate for the cause of refractory pleural effusion in pateients on HD.

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