Alterations of exocrine pancreas in end-stage renal disease do they reflect a clinically relevant uremic pancreopathy?

Abstract

Serum pancreatic enzyme behavior, exocrine function, and morphology of the pancreas were studied in 28 patients with end-stage renal disease undergoing regular hemodialysis, in order to better delineate and assess the clinical relevance of the pancreatic alterations that occur in these patients. Twenty-eight healthy subjects served as controls. Initial studies included serum amylase, isoamylase, and lipase assays; fecal chymotrypsin measurement; and abdominal ultrasonography. The amylase, lipase, and chymotrypsin determinations, as well as ultrasound examination, were repeated four years later. None of the patients had clinical evidence of pancreatic disease at entry into the study, but one had had previous attacks of pancreatitis and another developed mild acute pancreatitis one month after entry. Initial mean serum enzyme levels were significantly higher in patients than in controls (amylase, pancreatic isoamylase, and lipase, P < 0.001; salivary isoamylase P < 0.05). Serum amylase was raised in 16/28 patients; pancreatic isoamylase in 15/28, and lipase in 7/28; these elevations were generally mild. Mean fecal chymotrypsin was significantly lower (P < 0.001) in patients than in controls: abnormally low values were found in 9/28 patients. Amylase, lipase and chymotrypsin measurements repeated after four years showed no significant difference with respect to the first study. Ultrasonographic changes were rare and mild: one patient had a small cyst in the pancreas head, another, an increase in echogenicity of the gland not related to age; these findings were unchanged at repeat examination. The results demonstrate that the frequent elevations of serum pancreatic enzymes and the rare sonographic changes found in patients undergoing hemodialysis do not generally reflect a relevant pancreopathy. However, the finding of significantly decreased fecal chymotrypsin may indicate the presence of pancreatic dysfunction in end-stage renal disease.

Study of association of pancreatitis with enteric fever of age group 1 to 15 years

“…Cr-EDTA in two patients with elevated serum amylase levels in the course of entero-invasive salmonellosis. Hyperamylasemia and hyperlipasemia could also be the result of a reduced excretion due to either impaired renal or liver function [20,21].…”

Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency

“…In addition to the conditions described above, PEI occurs in patients with human immunodeficiency virus infection, alcohol-related liver cirrhosis,89,90 and end-stage renal disease91,92 (Figure 2), all of which are associated with high mortality rates. However, the underlying mechanisms are still unknown.…”

El páncreas en la uremia

“…Así, Ventrucci y cols. encuentran una disminución en la excreción fecal de quimiotripsina y de elastasa 1 en el 30% de los pacientes en HD (10,11). También se ha descrito en pacientes dializados una disminución de la secreción pancreática de amilasa y lipasa con la prueba de secretina-CCK (12).…”

“…Los pacientes con disminución del contenido de quimiotripsina y elastasa 1 descritos por Ventrucci y cols. estaban asintomáticos y la ecografía del páncreas era normal (10,11). En el estudio con autopsia de Vaziri y cols no se encontró relación entre las anormalidades histológicas y evidencia de enfermedad pancreática durante la estancia en diálisis, como por ejemplo pancreatitis aguda o crónica, o insuficiencia del páncreas exocrino (3).…”

“…La capacidad depurativa no es factor determinante ya que tanto en HD como en DPCA los aclaramientos de los diversos enzimas pancreáticos por el líquido de diálisis son insignificantes (34,54,55). Las elevaciones enzimáticas persisten estables en el tiempo, como se ha referido tras 4 años de seguimiento en un grupo de pacientes estables en HD (10).…”