First published online: 30 Jan 2016
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J Renal Inj Prev. 2016;5(1).
doi: 10.15171/jrip.2016.11
PMID: 27069969
PMCID: PMC4827387
  Abstract View: 161
  PDF Download: 80

Case Report

Pleuritic chest pain from portal hypertensive gastropathy in ESRD patient with autosomal dominant polycystic kidney disease misdiagnosed as pericarditis.

Macaulay Amechi Chukwukadibia Macaulay Amechi Chukwukadibia Onuigbo 1,2 * , Nneoma Agbasi 3, Jennifer Achebe 4, Charles Odenigbo 5, Fidelis Oguejiofor 5

1 Mayo Clinic College of Medicine, Rochester, USA
2 Department of Nephrology, Mayo Clinic Health System, Eau Claire, USA
3 North East London NHS Foundation Trust, UK
4 Aureus University School of Medicine, Oranjestad, Aruba
5 Department of Medicine, Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria
*Corresponding author: Macaulay Amechi Chukwukadibia Onuigbo, Email: onuigbo.macaulay@mayo.edu

Article

Chest pain in ESRD from ADPKD has a list of differential diagnosis which includes uremic pericarditis, acute coronary artery disease, pericardial effusion and rarely pericardial cysts, among others. We present a case of pleuritic chest pain secondary to portal hypertensive gastropathy (PHG) in a 24-year old Caucasian male patient with ADPKD who was on maintenance hemodialysis for ESRD, and who previously had been misdiagnosed as acute recurrent pericarditis. The management options for PHG are briefly discussed. Finally, we propose that PHG should be kept in the differential diagnosis of chest pain, pleuritic or non-pleuritic, with or without gastrointestinal symptoms, in patients with ADPKD, with or without renal failure. Moreover, the importance of a detailed medical history in the management of these patients cannot be over emphasized.

Implication for health policy/practice/research/medical education:

Portal hypertensive gastropathy (PHG) is a gastric mucosal lesion complicating portal hypertension, with higher prevalence in decompensated cirrhosis. PHG can sometimes complicate autosomal dominant polycystic kidney disease (ADPKD) due to the presence of multiple liver cysts. Besides, PHG is known to present as chest pain, with or without hematemesis. Other causes of chest pain in ADPKD include referred chest pain from progressively enlarging kidney cysts, and rare pericardial cysts. Chest pain, especially if pleuritic, in end-stage renal disease (ESRD) patients, is often ascribed to uremic pericarditis. We present recurrent pleuritic chest pain in a 24-year old ESRD patient with ADPKD that was initially misdiagnosed as uremic pericarditis. It was ultimately shown to represent symptomatic PHG with excellent therapeutic response to proton pump inhibitors.

Please cite this paper as: Onuigbo MAC, Agbasi N, Achebe J, Odenigbo C, Oguejiofor F. Pleuritic chest pain from portal hypertensive gastropathy in an end-stage renal disease patient with autosomal dominant polycystic kidney disease misdiagnosed as pericarditis. J Renal Inj Prev. 2016;5(1):48-52. DOI: 10.15171/jrip.2016.11

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