A Dramatic Presentation of Pulmonary Edema Due to Renal Failure

Pulmonary edema is a common cause of dyspnea and a leading reason for inpatient admission. Pulmonary edema results from accumulation of fluid or proteins in the alveoli, resulting in a ventilation perfusion mismatch, hence resulting in shortness of breath.1 The principal mechanisms underlying formation of pulmonary edema are transudation of protein poor fluid into the pulmonary interstitial and alveolar spaces, as happens in cardiogenic pulmonary edema; and increased permeability of the pulmonary endothelium as happens in non-cardiogenic causes such as acute respiratory distress syndrome (ARDS).1–3 Pulmonary edema etiology can be divided into cardiogenic and non-cardiogenic classes. By far, heart diseases are the leading cause of pulmonary edema in inpatient services.2 Non-cardiogenic pulmonary edema commonly is associated with acute respiratory distress syndrome and pulmonary embolism.4 Distant organ dysfunction such as renal failure is emerging as a cause of pulmonary edema, especially with widespread access to hemodialysis services and enhanced survival.5 Noncompliance with this lifesaving procedure, as is common with many medical prescriptions, is the leading reason for this association. This case report detailed a dramatic presentation of pulmonary edema due to noncompliance with hemodialysis.