Causes of Uremic Pleuritis & Key Considerations in Treatment

Uremic pleuritis, occurring in 15–20% of uremia patients, arises when failing kidneys can no longer filter toxins, allowing metabolic waste to accumulate and trigger systemic complications. Below we explore its causes and critical care guidelines.

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I. Causes of Uremic Pleuritis

1. Toxin Irritation: Accumulated waste increases pleural capillary permeability, impairing fluid transport.
2. Fluid Overload: Low plasma protein and elevated pulmonary vascular pressure cause pleural effusion.
3. Bleeding Tendency: Platelet dysfunction leads to hemorrhagic pleural fluid.
4. Tuberculosis Risk: Immune suppression raises susceptibility to tuberculous pleuritis.
5. Idiopathic Cases: Linked to hypermetabolism or viral infections during uremia.

II. Symptoms

Patients often experience chest pain, breathlessness, fever, or bloody sputum. Effusions (unilateral/bilateral) typically show:

• High protein/lactate dehydrogenase levels
• Lymphocyte-dominant or bloody fluid
• Possible fibrinous pleuritis with audible friction rubs (may coexist with pericardial rubs).

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III. Treatment & Recovery Guidelines

For Tuberculous Pleuritis:

• Recovery Criteria: Resolved symptoms, absorbed effusion, normal ESR, and minimal pleural thickening on X-ray.
• Post-Recovery Care:
  1. Complete Therapy: Strict 9–12 months of anti-TB drugs to prevent relapse.
  2. Follow-Ups: Biannual checkups for 4–5 years.
  3. Lifestyle:
     • Rest 2–3 months before resuming work.
     • Prioritize high-protein/vitamin diets (vegetables, fruits) and avoid alcohol/spicy foods.
     • Gradual exercise to rebuild immunity; prevent respiratory infections.

For Uremic Pleuritis:

• Address underlying kidney dysfunction (dialysis, toxin clearance).
• Monitor fluid balance and nutritional status rigorously.