Ewha Med J.  2016 Oct;39(4):125-128. 10.12771/emj.2016.39.4.125.

Corticosteroid Therapy for Refractory Uremic Pleurisy

• Park EJ
• Park MA
• Park MJ
• Park SY
• Lee SH

• KMID: 2356385
• DOI: http://doi.org/10.12771/emj.2016.39.4.125

Abstract

Uremic pleuritis is a fibrinous pleuritis of unknown pathogenesis in patients with chronic kidney disease. Although it responds to regular dialysis or repeated thoracentesis, cases that are refractory to those therapies have been reported. We report a case of uremic pleuritis which showed marked improvement following corticosteroid therapy. The effusion was exudate, and negative in cytology and microbiology. Pleural biopsy revealed chronic inflammation with fibrosis. The pleural effusion did not respond to chest tube drainage and continuance of hemodialysis. With a diagnosis of refractory uremic pleuritis, we started methylprednisolone. The pleural effusion responded to the treatment and resolved without complication.

Keyword

Uremia; Pleurisy; Hemodialysis; Corticosteroid

MeSH Terms

Biopsy
Chest Tubes
Diagnosis
Dialysis
Drainage
Exudates and Transudates
Fibrin
Fibrosis
Humans
Inflammation
Methylprednisolone
Pleural Effusion
Pleurisy*
Renal Dialysis
Renal Insufficiency, Chronic
Thoracentesis
Uremia
Fibrin
Methylprednisolone

Figure

• 

  Fig. 1 Chest imaging at presentation. Chest X-ray shows blunted both costophrenic angles (A). Chest computed tomography scan shows a large amount of pleural effusion with passive atelectasis in both hemithoraxes (B).

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  Fig. 2 Photographs of the pleural biopsy specimen. Thoracoscopic pleural biopsy shows chronic inflammation with fibrosis (H&E; A: ×100, B: ×200).

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  Fig. 3 Follow-up chest X-ray after treatment. After administration of methylprednisolone, the effusion gradually decreased in 2 weeks (A), and nearly completely resolved after 6 weeks of treatment (B).

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