From Nephrons to the Pericardium: Tamponade Physiology Secondary to IgA Nephropathy

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 02

Valeria Ramirez Lombana, MD

HCA (Hospital Corporation of America), Florida

Disclosure(s): No relevant financial relationship(s) to disclose.
MY

Manasi Yedavalli, n/a

Medical Student
Nova Southeastern University

Disclosure information not submitted.
CB

Christina Bedley, n/a

Medical Student
Nova Southeastern University

Disclosure information not submitted.
AR

Aitza Ramirez Perez, MD

Internal Medicine Resident
HCA Aventura

Disclosure information not submitted.
JN

John Nahas, MD

Internal Medicine Resident
HCA Aventura

Disclosure information not submitted.
PL

Prava Limbu, DO

Internal Medicine Resident
HCA Aventura

Disclosure information not submitted.
OB

Olesya Balashova, MD

Internal Medicine Resident
HCA Aventura

Disclosure information not submitted.

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.