Acute Kidney Injury Secondary to Cardiac Tamponade Caused by Severe Pericardial Effusion: A Case Report

Abstract

Introduction: Pericardial effusion frequently arises as a complication of systemic or cardiopulmonary disorders, and progressive accumulation may result in cardiac tamponade and multi-organ dysfunction. Although uncommon, acute kidney injury (AKI) associated with pericardial effusion is typically reversible when managed appropriately. Timely recognition of pericardial effusion in patients with unexplained respiratory distress and AKI is essential for prompt therapeutic interventions and prevention of irreversible kidney damage. Objective: To report the development, management, and follow-up of AKI in critically ill patients with tamponade-inducing pericardial effusion in this case report. This case occurred at Hazrat Vali-Asr Hospital in Borujen, Iran, in 2025. Case Presentation: A 77-year-old male with a history of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), and diabetes mellitus was admitted one week after starting amiodarone for atrial fibrillation, presenting with weakness, dyspnea, cough, and decreased O2 saturation. Investigations included chest computed tomography (CT, revealing bilateral pleural effusions), blood tests (metabolic acidosis, urea 135 mg/dL, creatinine 2.9 mg/dL), and kidney ultrasound (normal). Despite supportive care and temporary hemodialysis, the patient’s respiratory status deteriorated, and creatinine levels continued to rise. Discussion: This case highlights the importance of early detection of pericardial effusions in patients with unexplained respiratory distress and acute renal impairment. The underlying pathophysiology of acute renal impairment in this setting is predominantly hemodynamic. Elevated right atrial pressure combined with systemic venous congestion compromises blood flow to the kidneys, and the development of tamponade compounds these effects. Often, supportive therapy alone is not sufficient; however, timely pericardiocentesis can rapidly restore kidney function by reducing the pressure in the heart and improving cardiac output. This is an example of cardiorenal type 1 syndrome, where acute cardiac dysfunction leads to reversible acute renal impairment. Conclusions: Pericardial drainage can improve renal function secondary to pericardial effusion by reducing right atrial pressure, relieving venous congestion, and enhancing renal perfusion. Therefore, in patients presenting with unexplained AKI and respiratory distress, pericardial effusion should be considered in the differential diagnosis.