Bakirci T, Sasak G, Ozturk S, Akcay S, Sezer S, Haberal M
Baskent University, Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey.
Transplant Proc. 2007 May;39(4):889-91. doi: 10.1016/j.transproceed.2007.02.020.
As a consequence of the expanded use of long-term hemodialysis and extended life spans, complications of chronic renal failure are encountered with an increased frequency among uremic patients. Such patients may develop many thoracic and extrathoracic problems--most frequently uremic pleuritis and pericarditis, uremic pneumonia, infection, and metastatic pulmonary calcification. We retrospectively analyzed the medical records of 257 patients who had received long-term hemodialysis between 1990 and 2006 to better understand the incidence, causes, and clinical features of pleural effusions in this population. The incidence of pleural effusion in hospitalized patients receiving long-term hemodialysis was 20.2% (n=52; mean age, 55.83 +/- 16.56 years; male-to-female ratio, approximately 3:2). Pleural effusion resulted from hypervolemia in 61.5% and was bilateral in 68.8% of patients. Unilateral effusion was present in 25 of 52 (48%) patients. The most frequent causes of unilateral effusion were hypervolemia (n=9) and parapneumonic effusion (n=5). Thoracenteses were performed in 14 of the 52 patients in the study group. Of thoracenteses performed, 64.3% of the patients had transudative pleural effusion and 35.7% had exudative effusion. Transudative pleural effusion resulted from hypervolemia in 66.7% and heart failure in 22.2%. Of the patients with transudative effusion, 85.7% were bilateral. The most frequent cause of exudative pleural effusion was uremic pleuritis, which occurred in 40% of the patients. The most common symptom was dyspnea, which occurred in 53.8% of patients. In conclusion, pleural effusions are common in patients receiving chronic hemodialysis. Thoracentesis may be performed in patients with unilateral pleural effusion. Since hypervolemia was the most common cause of pleural effusion, this complication should not be considered an obstacle in renal transplant recipients.
由于长期血液透析的广泛应用以及患者寿命的延长，慢性肾衰竭的并发症在尿毒症患者中出现的频率增加。这类患者可能会出现许多胸内和胸外问题，最常见的是尿毒症胸膜炎和心包炎、尿毒症肺炎、感染以及转移性肺钙化。我们回顾性分析了1990年至2006年间接受长期血液透析的257例患者的病历，以更好地了解该人群胸腔积液的发生率、病因及临床特征。接受长期血液透析的住院患者胸腔积液的发生率为20.2%（n = 52；平均年龄55.83±16.56岁；男女比例约为3:2）。61.5%的胸腔积液由血容量过多引起，68.8%的患者为双侧胸腔积液。52例患者中有25例（48%）为单侧胸腔积液。单侧胸腔积液最常见的病因是血容量过多（n = 9）和类肺炎性胸腔积液（n = 5）。研究组52例患者中有14例进行了胸腔穿刺。在进行胸腔穿刺的患者中，64.3%为漏出性胸腔积液，35.7%为渗出性胸腔积液。66.7%的漏出性胸腔积液由血容量过多引起，22.2%由心力衰竭引起。在漏出性胸腔积液患者中，85.7%为双侧胸腔积液。渗出性胸腔积液最常见的病因是尿毒症胸膜炎，40%的患者出现该病因。最常见的症状是呼吸困难，53.8%的患者出现此症状。总之，胸腔积液在接受慢性血液透析的患者中很常见。单侧胸腔积液患者可进行胸腔穿刺。由于血容量过多是胸腔积液最常见的原因之一，因此该并发症不应被视为肾移植受者的障碍。
