[Pulmonary hypertension in end-stage renal disease: three case reports].

Abstract

HISTORY:

Within three months, three patients with end-stage renal disease presented for evaluation of pulmonary hypertension (PH): a 72-year-old woman (case 1), a 67-year-old patient (case 2) and a 75-year-old patient (case 3), each with increasing dyspnea (WHO functional class III).

INVESTIGATIONS:

In all three cases, there was echocardiographic evidence of right heart failure; right heart catheterization was completed before and after dialysis. In case 1, we found a postcapillary PH (PH group 2 - PH with left heart diseases/diastolic dysfunction). Case 2 also showed a postcapillary PH and a high cardiac output of 9.7 l/min. In case 3, unmasked after dialysis, a precapillary, pulmonary arterial hypertension (PAH - group 1) was detected.

TREATMENT AND COURSE:

In patient 1, no relevant improvement of symptoms was observed, despite optimized cardiac therapy. There was a significant clinical improvement in patient 2 after surgical reduction of the arteriovenous shunt. In patient 3, relevant clinical and hemodynamic improvement was seen under treatment with bosentan.

CONCLUSION:

These cases confirm the role of right heart catheterization in the differential diagnosis of unclear PH in patients with end-stage renal failure. Moreover, the three cases point to three different causes. Specific therapies can result in significant symptomatic improvement.

• Authors: S Pabst, C Hammerstingl, F Hundt, T Gerhardt, G Nickenig, R Woitas, D Skowasch
• Journal: Deutsche medizinische Wochenschrift (1946) (Dtsch Med Wochenschr) Vol. 136 Issue 18 Pg. 944-7 (May 2011) ISSN: 1439-4413 [Electronic] Germany
• Vernacular Title: Pulmonale Hypertonie bei terminaler Niereninsuffizienz: Drei Kasuistiken.
• PMID: 21526458 (Publication Type: Case Reports, English Abstract, Journal Article)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Aged
• Arteriovenous Shunt, Surgical (adverse effects)
• Blood Flow Velocity (physiology)
• Cardiac Catheterization
• Diagnosis, Differential
• Echocardiography
• Female
• Heart Failure (diagnosis, etiology, physiopathology, therapy)
• Humans
• Hypertension, Pulmonary (diagnosis, etiology, physiopathology, therapy)
• Kidney Failure, Chronic (complications, physiopathology, therapy)
• Male
• Pulmonary Wedge Pressure (physiology)
• Renal Dialysis
• Stroke Volume (physiology)
• Ventricular Dysfunction, Left (complications, diagnosis, therapy)
• Ventricular Function, Left (physiology)