The prevalence of elevated liver enzymes and acute renal failure is high and the differential diagnosis of both conditions, separately and combined, is extensive. We present two cases of rapidly increasing liver enzymes in combination with (oliguric) renal failure with surprising outcomes. In both cases the medical condition was caused by cardiac tamponade with almost complete restoration of both renal and liver function after pericardiocentesis. Pericardial effusion can be a complication of numerous medical conditions, such as malignancies, trauma, metabolic disorders and infections. In some cases, the accumulation of pericardial fluid results in cardiac tamponade with subsequent cardiogenic shock. This life-threatening condition can then lead to multiple organ dysfunction and, unless treated promptly, even to death. Both described cases of cardiac tamponade underline the necessity of a thorough search for the underlying cause of elevated liver enzymes and acute renal failure.
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