133: From Nephrons to the Pericardium: Tamponade Physiology Secondary to Iga Nephropathy

Introduction: IgA nephropathy is the most common primary glomerulonephritis worldwide. While many cases follow an indolent course, over 50% of cases progress to end-stage renal disease (ESRD) within 30 years. Uremic pericarditis is a rare complication of ESRD and may present with life-threatening cardiac tamponade. Early recognition is critical, yet clinical suspicion may be low in non-dialysis patients. Methods: We present the case of a 39-year-old Hispanic female with a two year history of biopsy-confirmed IgA nephropathy who presented to the emergency department with complaints of worsening dyspnea and pleuritic chest pain for 3 days. On presentation, the patient was hypertensive, tachycardic, tachypneic, with oxygen saturation around 80%. Initial laboratory studies demonstrated markedly elevated blood urea nitrogen and creatinine, consistent with uremia. Initial echocardiogram showed a moderate-sized pericardial effusion with no criteria for tamponade. Repeat echo seven days later revealed a large pericardial effusion with features of tamponade prompting urgent pericardiocentesis with 1.7L of hemorrhagic pericardial fluid removed. There was subsequently reaccumulation of the pericardial effusion requiring a pericardial window. Pericardial fluid analysis was negative for infection or malignancy. Results: This case highlights an uncommon but serious complication of IgA nephropathy—uremic pericarditis with tamponade physiology. Although pericardial effusion is recognized in advanced renal disease, tamponade remains a rare and under-reported manifestation, particularly in patients not yet on dialysis. Conclusions: Clinicians should maintain a high index of suspicion for pericardial complications in patients with advanced IgA nephropathy presenting with cardiopulmonary symptoms. Early echocardiography and timely intervention are crucial to prevent fatal outcomes.