Refractory exudative pleural effusion in patients with chronic kidney disease not receiving dialysis: A case report

Pleural effusion is a common complication in patients with chronic kidney disease (CKD), particularly in those with end‐stage renal disease (ESRD). Transudative pleural effusion is commonly caused by hypervolemia, whereas exudative pleural effusion can be caused by infections such as tuberculosis, malignancies, and connective tissue diseases.1, 2, 3, 4, 5 Uremic pleuritis, which is a diagnosis of exclusion and results from inflammation of the visceral and parietal pleura, can also cause exudative pleural effusion.1, 6, 7, 8, 9 Although the pathogenesis of uremic pleuritis remains uncertain, it has primarily been reported in patients with ESRD receiving dialysis. Intensifying renal replacement regimens is effective in these patients.1, 6, 9, 10 Only a few cases of CKD associated pleural effusion have been reported in patients during the predialysis stage, even among those in whom the effusion is expected to resolve after the initiation of dialysis. We describe exudative pleural effusion in a CKD patient not receiving dialysis. The patient was refractory to conventional treatment such as continuous renal replacement therapy but improved completely with corticosteroid therapy.