Description

A 70-year-old man, a case of diabetes mellitus with nephropathy, presented with malaise, poor appetite and progressive shortness of breath for 1 week. Physical examination showed crackles at bilateral lung fields and no oedema of limbs. His blood urea nitrogen (BUN) and serum creatine levels were 245 and 33 mg/dL, respectively. Anaemia (haemoglobin 6.4 g/dL) and hypoalbuminaemia (albumin 2.6 g/dL) were also noticed. The ECG showed a sinus rhythm without significant ST-T wave changes. Chest radiography showed bilateral perihilar pulmonary consolidations with a clear periphery (figure 1A). He was haemodialysed for uraemia with uraemic lung. One week later, the levels of BUN (103 mg/dL) and serum creatine (14.5 mg/dL) decreased and without a significantly negative fluid balance, complete resolution of pulmonary opacities was achieved in the follow-up chest radiography (figure 1B).

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Figure 1

(A) Chest X-ray at arrival showing bilateral perihilar consolidations with right lung predominance. (B) chest X-ray 1 week later showing complete resolution of pulmonary consolidations.

Uraemic lung is a severe pulmonary complication observed in patients with uraemia.1 Besides fluid overload, it could be attributed to miscellaneous mechanisms, such as increased lung vascular permeability and inflammation induced by chemokines and leucocytes.1 ,2 It is important to differentiate uraemic lung from other causes of lung oedema. A previous radiology study had shown that more lung oedema in renal failure had central distribution of pulmonary opacities while more lung oedema in heart failure had cephalisation of pulmonary vessels.3 Likewise, the reported cases of uraemic lung were characterised by perihilar opacities with a clear periphery.1 Although uraemia related distant organ damage still has a substantial impact on mortality, dialysis remains the most important treatment for a better outcome.2