title: [Pulmonary hypertension in end-stage renal disease: three case reports].
abstract: METHODS
  Within three months, three patients with end-stage renal disease presented for evaluation of pulmonary hypertension (PH): a 72-year-old woman (case 1), a 67-year-old patient (case 2) and a 75-year-old patient (case 3), each with increasing dyspnea (WHO functional class III).
  
  
  METHODS
  In all three cases, there was echocardiographic evidence of right heart failure; right heart catheterization was completed before and after dialysis. In case 1, we found a postcapillary PH (PH group 2 - PH with left heart diseases/diastolic dysfunction). Case 2 also showed a postcapillary PH and a high cardiac output of 9.7 l/min. In case 3, unmasked after dialysis, a precapillary, pulmonary arterial hypertension (PAH - group 1) was detected.
  
  
  METHODS
  In patient 1, no relevant improvement of symptoms was observed, despite optimized cardiac therapy. There was a significant clinical improvement in patient 2 after surgical reduction of the arteriovenous shunt. In patient 3, relevant clinical and hemodynamic improvement was seen under treatment with bosentan.
  
  
  CONCLUSIONS
  These cases confirm the role of right heart catheterization in the differential diagnosis of unclear PH in patients with end-stage renal failure. Moreover, the three cases point to three different causes. Specific therapies can result in significant symptomatic improvement.
authors.affiliation: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn.
authors.forename: S
authors.initials: S
authors.lastname: Pabst
authors.forename: C
authors.initials: C
authors.lastname: Hammerstingl
authors.forename: F
authors.initials: F
authors.lastname: Hundt
authors.forename: T
authors.initials: T
authors.lastname: Gerhardt
authors.forename: G
authors.initials: G
authors.lastname: Nickenig
authors.forename: R
authors.initials: R
authors.lastname: Woitas
authors.forename: D
authors.initials: D
authors.lastname: Skowasch
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D001783:Blood Flow Velocity / Q000502:physiology; D006328:Cardiac Catheterization; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D006435:Renal Dialysis; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology