Pleural effusion and renal failure

Gabrielle Morris

76 yo lady for VATS pleurodesis – drainage pleural effusion 

Background 

  • IDDM
    • IHD – CABG 2016, stents x2 since, o Angio 2020 all are occluded except 1 
    • PPM – 3rd degree HB o AF underlying rhythm 
    • Moderate MR 
    • Pulmonary hypertension 

Issues 

Large symptomatic pleural effusion – aetiology unknown

  • Large symptomatic pleural effusion
    • Transudate 
    • Malignancy vs cardiac vs renal overload 
    • Recent Weight loss 
    • Failed conservative treatment – had pigtail catheter inserted and fluid drained. Talc down drain before removal. Immediate reaccumulation 
    • pro BNP > 45 000 
  • ESRD – dialysis dependent o Anuric 
    • Fluid removal limited by limited by hypotension 
    • Hyperkalemia 

Discussion 

Proceed to surgery? 

  • High risk patient – NSQUIP mortality 20% 
  • Non-operative management has failed 

Opportunity for optimisation? 

  • Renal team – any options for dialysis. Renal palliative care team involvement 
  • cardiologist review and advice

Treating symptoms v. investigation of underlying cause

  • Should she have malignancy workup?

Plan 

  • Cardiologist referral –discuss with Dr Collins next week 
  • Discuss with surgical team and renal team regarding requirement for further investigations/optimisation 
  • Suggest referral to renal palliative care