Macaulay Amechi Chukwukadibia Macaulay Amechi Chukwukadibia Onuigbo
1,2*, Nneoma Agbasi
3, Jennifer Achebe
4, Charles Odenigbo
5, Fidelis Oguejiofor
51 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
Abstract
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