Pleural effusion in a patient with end-stage renal disease

Pleural disease is a common problem in patients with chronic renal insufficiency. In 1836, Bright reported that only 29% of patients with albuminous urine had healthy pleura at autopsy. There areseveral reasons why pleural disease may be common in patients with renal failure. These include congestive heart failure, an increased risk of infection, the presence of diseases associated with renal and pleural manifestations (eg, systemic lupus erythematosus), uremic pericarditis, an increased risk for certain malignancies and pulmonary embolism. Uremic pleurisy results from an unknown putative agent, and therefore uremic pleuritis is a diagnosis of exclusion.