Introduction: Pericardial effusion resulting from uremic pericarditis is a complication associated with chronic kidney disease (CKD). In patients with advanced CKD or End Stage renal disease (ESRD) renal transplant is the definitive treatment to improve long term outcomes. However, the presence of a large pericardial effusion poses a risk of hemodynamic compromise during transplant surgery. Options of stabilizing the patient with aggressive dialysis, pericardiocentesis or pericardial window can be considered. Here we present a case of a patient with advanced CKD who underwent pre-emptive kidney transplant and in three months had complete resolution of a large pericardial effusion noted pre-operatively. Case Presentation: A 48-year-old African American male with advanced CKD stage V secondary to Focal segmental glomerulosclerosis (FSGS) presented for pre-emptive deceased donor renal transplant. During his pre-operative testing, apart from severe azotemia, he was noted to have a CXR with severely enlarged cardiac silhouette. An echocardiogram revealed a large pericardial effusion without signs of hemodynamic compromise. The patient underwent a successful renal transplantation without any perioperative complications. Post transplantation patient’s renal functions normalized in a week with a serum creatinine of 1.2mg/dl. A follow up Echocardiogram done 3 months later revealed complete resolution of pericardial effusion. Learning Points: The literature is scant of cases describing resolution of pericardial effusion following a kidney transplant. This uniqueness adds interest to this case. In a Retrospective chart review of ESRD patients undergoing evaluation for renal transplant moderate to large pericardial effusions were noted with a prevalence of 1.9 %. This case highlights the fact that complete and rapid resolution of uremic pericardial effusion following a kidney transplant is possible. The presence of uremic pericardial effusion should not be a barrier to timely transplantation.

Analytical, Diagnostic and Therapeutic Techniques and Equipment
Cardiovascular Diseases
Diseases
Internal Medicine
Male Urogenital Diseases
Medical Specialties
Medicine and Health Sciences
Surgical Procedures, Operative