Acute renal failure during immediate post transplant period due to a pericardial effusion.
BACKGROUND
Pericardial effusions and acute renal failure are common findings in clinical practice. However, acute renal failure resulting from pericardial effusions (without tamponade) is a rare finding. We report the first such case to occur in a transplanted kidney.


METHODS
A 20-year-old Sri Lankan male presented with hypertensive crisis in the background of end stage renal failure. He was thoroughly investigated for secondary causes of hypertension to no avail. He was hemodialysed adequately for 6 months, while being worked up for transplantation. He received an ABO matched, living donor transplant. Immediate post-operative period his urine outputs were poor, soon to became anuric by 6 h post-transplant. Elevated liver enzymes and non-specific increase of resistivity indexes (0.84-0.88) at the Doppler scan raised the possibility of venous hypertension. An echocardiogram showed a moderately large pericardial effusion which was tapped, and found to be a transudate. He started producing urine within 6 h, entered polyuric phase by day 3, and by day 7 his creatinine dropped to reference levels. Vasculitis screen, anti nuclear factor, viral screen, and rickettsia serology were negative. Albumin levels on day 2 were 27 g/l and were replaced using human albumin. The exact cause of pericardial effusion is unclear but hypoalbuminemia, drug-induced and idiopathic are possible causes. He has excellent graft function, no recurrences or constrictive pericarditis after 2 years follow.


CONCLUSIONS
We recommend any patient who has delayed graft function and raised central venous pressures to have an echocardiogram to exclude pericardial effusions. The response to pericardiocentesis had been universally good in reported cases.
University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 9, Sri Lanka. rangamw2003@yahoo.com.
Ranga Migara
RM
Weerakkody
Department of Anesthesiology, National Hospital of Sri Lanka, Regent Street, Colombo 9, Sri Lanka. pnlokuliyana@ymail.com.
Pushpa Nandani
PN
Lokuliyana
Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka. rezvi.sheriff@gmail.com.
Mohammed Hussain Rezvi
MH
Sheriff
D058186:Acute Kidney Injury / Q000209:etiology* / Q000652:urine; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010490:Pericardial Effusion / Q000150:complications* / Q000652:urine; D000069236:Pericardial Fluid / Q000378:metabolism; D055815:Young Adult