Pulmonary embolism in a 51-year-old woman with chronic kidney disease

Main Article Content

Triwedya Indra Dewi
Melawati Hasan
Fathy Fathini


Chronic kidney disease (CKD) is a worldwide public health problem both in terms of the number of patients and the cost of treatment. Chronic kidney disease seems to be the main driver of pulmonary embolism (PE) in dialysis patients. The diagnosis of PE is difficult due to its non-specific signs and symptoms, especially in many comorbidities with similar features. Chronic kidney disease plays a role in both the incidence of venous thromboembolism and the manifestations of pulmonary hypertension, resulting in an increased risk of morbidity and mortality. Advances in the management of patients with suspected PE have improved diagnostic accuracy. An approach using several diagnostic tools with different characteristics, such as D-dimer measurement, and imaging tests-predominantly computed tomography pulmonary angiography (CTPA) - can help evaluate the diagnosis.

Case Description
Here we report the case of a 51-year-old woman with a history of chronic kidney disease, who presented with sudden worsening of dyspnea. Further examination showed signs of right heart failure with a high probability of pulmonary hypertension on echocardiography. Based on the general features it is difficult to distinguish between acute pulmonary embolism and chronic pulmonary hypertension, both of which can be caused by the underlying chronic kidney disease. Nevertheless, gold standard imaging using CTPA confirmed the diagnosis of pulmonary embolism, with underlying pulmonary hypertension from chronic kidney disease.

The diagnosis of pulmonary embolism with comorbidities is challenging. The availability of diagnostic modalities will confer different advantages and particular accuracy to meet the challenges in diagnosis.

Article Details

How to Cite
Indra Dewi, T., Hasan, M., & Fathini, F. (2021). Pulmonary embolism in a 51-year-old woman with chronic kidney disease . Universa Medicina, 40(2). Retrieved from https://univmed.org/ejurnal/index.php/medicina/article/view/1085
Case Report


Hill NR, Fatoba ST, Oke JL, et al. Global prevalence of chronic kidney disease – a systematic review and meta-analysis. PLoS One 2016; 11: e0158765. doi: 10.1371/journal.pone.0158765.

Kumar G, Sakhuja A, Taneja A, et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012;7:1584–90. DOI: https://doi.org/10.2215/CJN.00250112.

Nishiyama KH, Saboo SS, Tanabe Y, Jasinowodolinski D, Landay MJ, Kay FU. Chronic pulmonary embolism: diagnosis. Cardiovasc Diagn Ther 2018;8:253–71. doi: 10.21037/cdt.2018.01.09.

Konstantinides SV, Meyer G, Bueno H, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J 2020;41:543–603. doi: 10.1093/eurheartj/ehz405.

Howard L. Acute pulmonary embolism published correction appears in Clin Med (Lond) 2019;19:243-7. doi: 10.7861/clinmedicine.19-3-247.

Morrone D, Morrone V. Acute pulmonary embolism: focus on the clinical picture. Korean Circ J 2018;48:365–81. doi: 10.4070/kcj.2017.0314.

Konstantinides S V. Trends in incidence versus case fatality rates of pulmonary embolism: Good news or bad news? Thromb Haemost 2016;115:233-5. doi: 10.1160/th15-10-0832.

Kumar G, Sakhuja A, Taneja A, et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012;7:1584-90. doi: 10.2215/CJN.00250112.

Hariharan P, Dudzinski DM, Okechukwu I, Takayesu JK, Chang Y, Kabrhel C. Association between electrocardiographic findings, right heart strain, and short-term adverse clinical events in patients with acute pulmonary embolism. Clin Cardiol 2015;38:236-42. doi:10.1002/clc.22383.

Dabbouseh NM, Patel JJ, Bergl PA. Role of echocardiography in managing acute pulmonary embolism. Heart 2019;105:1785-92. doi: 10.1136/heartjnl-2019-314776.

Ascha M, Renapurkar RD, Tonelli AR. A review of imaging modalities in pulmonary hypertension. Ann Thorac Med 2017;12:61–73. doi: 10.4103/1817-1737.203742.

Moore AJE, Wachsmann J, Chamarthy MR, Panjikaran L, Tanabe Y, Rajiah P. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018;8:225-43. doi:10.21037/cdt.2017.12.01.

Hur DJ, Sugeng L. Non-invasive multimodality cardiovascular imaging of the right heart and pulmonary circulation in pulmonary hypertension. Front Cardiovasc Med 2019;6:24. doi: 10.3389/fcvm.2019.00024.

Pabst S, Hammerstingl C, Hundt F, et al. Pulmonary hypertension in patients with chronic kidney disease on dialysis and without dialysis: results of the PEPPER-study. PLoS One 2012;7. doi: 10.1371/journal.pone.0035310.

Amerling R, Ronco C, Kuhlman M, Winchester JF. Arteriovenous fistula toxicity. Blood Purif 2011;31:113–20. DOI: 10.1159/000322695.

O’Leary JM, Assad TR, Xu M, et al. Pulmonary hypertension in patients with chronic kidney disease: invasive hemodynamic etiology and outcomes. Pulm Circ 2017;7:674–83. doi: 10.1177/2045893217716108.