Which of the following findings in a patient with advanced CKD constitutes an absolute indication for initiation of urgent dialysis?
- A Uraemic serositis presenting as fibrinous pericarditis with a pericardial rub ✓
- B Serum creatinine of 9 mg/dL with urine output 900 mL/day
- C Blood urea nitrogen of 85 mg/dL with intact sensorium
- D Metabolic acidosis with bicarbonate of 19 mEq/L
Correct answer: A. Uraemic serositis presenting as fibrinous pericarditis with a pericardial rub
Explanation
Uraemic pericarditis signals severe uraemia and risks progression to tamponade or haemorrhagic effusion, making it an absolute indication for urgent dialysis alongside refractory hyperkalaemia, refractory pulmonary oedema, severe uncontrollable acidosis, and uraemic encephalopathy. An elevated BUN or creatinine alone, preserved urine output, and mild to moderate acidosis are relative indications managed with medical therapy and close monitoring until other thresholds are crossed.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.