Pericardial Effusion (PE) is a common clinical entity that is routinely diagnosed by echocardiography. The presenting syndrome depends on the volume, rate of accumulation and characteristics of fluid. Tuberculous Pericardial Effusion (TPE) is an accumulation of fluid in the pericardial cavity with Mycobacterium tuberculosis (MTB) in the immunocompromised patients and it is uncommon form of extra-pulmonary tuberculosis being increasingly found with common symptoms of chest pain, dyspnea, weight loss, general weakness. In this case report patient is in early stage CKD, 2D-Echocardiogram revealed a large pericardial effusion with fibrin strands. Usually in many cases pericardial effusion occur in end-stage renal failure but in this case pericardial effusion was seen in early stage. In endemic areas mostly MTB may cause PE in early stage of chronic renal failure. The patient was treated and responded well with ATT and other supportive therapy.