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February 20, 1981

Fibrosing Uremic Pleuritis During Hemodialysis

JAMA. 1981;245(7):705. doi:10.1001/jama.1981.03310320029015

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To the Editor.—  Regarding the recent article by Rodelas et al (1980;243:2424) entitled "Fibrosing Uremic Pleuritis During Hemodialysis," the authors point out that there have been only three patients previously described with this entity. We therefore wish to report our experience with three additional patients that we have cared for during the past three years.All patients were men and had weight loss, intermittent fever, dyspnea on exertion, and a severe restrictive defect on pulmonary function testing.Although chest x-ray films uniformly showed large unilateral pleural effusions, thoracentesis generally yielded only small amounts of fluid and was therapeutically of no benefit. Findings from diagnostic studies on the pleural fluid consistently showed an exudate with characteristics similar to those reported in the current article. Additionally, several cultures for bacterial, fungal, and acid-fast organisms were negative.In all three patients surgical decortication was required. At surgery constrictive pleuritis with fibrous peels