Received: 20 June 2001 Final revision received: 3 September 2001 Accepted: 3 September 2001 Published online: 25 October 2001  Springer-Verlag 2001 E.Zakynthinos  ) ) ´ T.Vassilakopoulos ´ P.Politis ´ Z.Daniil ´ C.Roussos ´ S.G.Zakynthinos Department of Critical Care and Pulmonary Services, University of Athens Medical School, `Evangelismos' Hospital, 45±47 Ipsilantou Street, 10675, Athens, Greece E-mail: ezakynth@yahoo.com Phone: +30-1-7243320 Fax: +30-1-7216503 Uremic pericarditis in acute renal failure ARF) is rare [1]. Moreover, tamponade is a quite unexpected compli- cation [2]. In a period of 3 years, three patients developed hem- orrhagic uremic cardiac tamponade in the course of pro- longed ARF, treated by continuous venovenous hemo- filtration CVVH) for 35±48 days. CVVH was instituted early during hospitalization. All three patients aged 21, 28 and 40 years) were admitted to our ICU after trau- matic insults. Renal hypoperfusion due to hemorrhage and severe sepsis seemed to be the main cause for ARF in two patients, and sepsis combined with rhabdomyoly- sis and myoglobinuria in the third. Cardiac systolic func- tion, assessed by echocardiography, was normal in all. Within a few days of CVVH termination, transthoracic echocardiography revealed the presence of significant pericardial effusion progressing to cardiac tamponade in the next 2±5 days Fig. 1A, B). Tamponade was also documented by right heart catheterization elevation and equilibration of right and left heart filling pressures) and was associated with hemodynamic instability. Per- cutaneous catheter pericardiocentesis under echocardi- ography, with continued catheter drainage of the peri- cardial sac for 48±72 h, was performed [3]. In all cases, 420±740 cc of hemorrhagic fluid Hb 2.2±5.9 g/dl, pro- Epaminondas Zakynthinos Theodoros Vassilakopoulos Panagiotis Politis Zoi Daniil Charis Roussos Spyros G. Zakynthinos Uremic pericarditis with tamponade following prolonged continuous hemofiltration Intensive Care Med 2001) 27: 1958±1959 DOI 10.1007/s00134-001-1118-0 BRIEF REPORT Fig. 1 A, B Transthoracicechocardiogram. A Four-chamber apical 2-D view; B transmitral Doppler pattern. Tamponade: large peri- cardial effusion PE) adjacent to borders of right ventricle RV), right atrium RA) and left ventricle LV). Diastolic RA collapse arrow) is present A). An abrupt reduction in mitral flow velocity on inspiration INSP) is shown B)