Disorders of the Pleura |

Pleural Complications in Patients With Chronic and End-Stage Renal Disease FREE TO VIEW

Hamdy Mahmoud, MD; Azza Mahmoud, MD; Ismail Mobarak, MD; Ali Hassan, MD
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Chest Diseases and Tuberculosis, Sohag University-Sohag Faculty of Medicine, Sohag-Elmaragha-Nagecc Elhakim, Egypt

Chest. 2014;146(4_MeetingAbstracts):434A. doi:10.1378/chest.1976968
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SESSION TITLE: Pleural Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To find out the clinical presentation, causes and outcomes of pleural complications in CKD and ESRD patients receiving haemodialysis.

METHODS: One hundred thirty patients with CKD and ESRD receiving haemodialysis were included in this study. The following parameters were analyzed: Patients demographic data, causes, location, CBC, ESR ,serum albumin, sputum profile, chest X ray and USG findings and pleural fluid analysis.

RESULTS: The incidence of pleural effusions in patients with CKD and ESRD receiving hemodialysis was 80.8%, followed by Pyopneumothorax (11.5%) then Iatrogenic Pneumothorax (7.7%).Most common cause of PE was found to be parapneumonic effusion 28.6%, followed byhypervolaemia 24.8% , heart failure 14.3%,uraemic pleurisy 9.5% and hypoalbuminaemia . Three of 105 (3%) PEs wereempyemas.Patients with parapneumonic effusions (p=0.0006), uremic,and tuberculosis (p=0.003),were more likely to have unilateral PEs than patients with hypervolaemia& heart failure, also patients withPyopneumothorax& Pneumothorax .Shortness of breath , cough , fever and chest pain are the most common mode of clinical presentation. Pleural fluid analysis showed that Pl. to serum protein ratio, total pl. leukocytes and polymorphonuclear (%) were significantly higher in patients with parapneumonic eff.compared to patients with other causes of effusion, whereas Lymphocytes (%) was significantly higher in patients with other causes of effusion especially tuberculous eff. compared to patients with parapneumonic eff. Serum albumin was significantly lower in patients with nephrotic syndrome. Seven CKD patients and 11 ESRD patients had empyemas&pyopneumothorax. Empyema culture findings were positive in 16 patients(88.9%) : Aerobic G. Norganisms, especially K.pneumoniae, were the predominant pathogens in 11 patients (68.8%) ; aerobic G. P organisms,especially S.aureus, in 5 patients (31.3%).Improvement was achieved in 87.7% of patients with pleural complications by continuation of HD, antibiotics, diuretics, antituberculous drugs and chest tube insertion.

CONCLUSIONS: Pleural effusions are the most common pleural complications followed bypyopneumothorax in patients with CKD & ESRD. The most common cause of unilateral pleural effusion isparapneumonic effusion followed by uremic pleuritis while in bilateral pleural effusion ishypervolaemia& congestive cardiac failure.

CLINICAL IMPLICATIONS: Awearness with causes of pleural complications in CKD & ESRD help physion to take correct dicision of treatment with great benifit to patients.

DISCLOSURE: The following authors have nothing to disclose: Hamdy Mahmoud, Azza Mahmoud, Ismail Mobarak, Ali Hassan

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