Predisposition to acute pancreatitis in dogs with severe acute renal failure

Abstract

Patients with acute renal failure often have a negative energy balance, which promotes metabolic changes predisposing to complications. The objective of this study was to evaluate laboratory parameters of 30 dogs with severe acute renal failure, to assess their relationship with the possibility of developing acute pancreatitis due to the negative energy balance, and to correlate these findings with the degree of renal failure. Serum concentrations of urea, creatinine, beta-hydroxybutyrate, triglycerides, amylase, total lipase, and canine pancreatic lipase were compared between healthy dogs and dogs with severe acute renal failure. A greater serum concentration of beta-hydroxybutyrate and greater activity of pancreatic enzymes, particularly canine pancreatic lipase, as well as a stronger correlation between the latter and serum creatinine concentrations, were related to the occurrence of acute pancreatitis in patients with severe acute renal failure. A greater degree of renal failure implied a greater predisposition to acute pancreatitis.

Hyperlipasemia in dogs with acute kidney injury treated with and without hemodialysis

“…Moreover, cPL concentrations were measured at the request of clinicians in the latter study, presumably because AP was suspected, but DGGR‐lipase was measured in our study regardless of clinicians' suspected diagnoses. Similarly, another study found cPL concentrations ≥400 μg/L either at admission or within the first 8 days of hospitalization in 71% of 28 dogs with AKI of IRIS Grades 3–5 not undergoing HD 14 . Lipase activity also was measured in that study and reported to be significantly higher in dogs with AKI compared to healthy control dogs, but neither the assay method nor the prevalence of increased lipase activity were disclosed.…”

“…We found that high DGGR‐lipase activity at admission and particularly during hospitalization was associated with high IRIS grades, although correlation of DGGR‐lipase activity and plasma creatinine concentrations at admission was poor. One previous study in dogs, in which cPL concentrations ≥400 μg/L were measured within 1–8 days of admission in 71% of 28 dogs with IRIS Grades 3–5, found a positive correlation between cPL and plasma creatinine concentrations, which was interpreted as evidence of predisposition to AP in dogs with severe AKI 14 . However, dogs with AKI were compared to healthy controls and the extent to which the severity of AKI was associated with increased cPL concentrations was not evaluated.…”

“…Lipase activity also was measured in that study and reported to be significantly higher in dogs with AKI compared to healthy control dogs, but neither the assay method nor the prevalence of increased lipase activity were disclosed. Authors of both studies apparently interpreted increased cPL concentrations as evidence for pancreatitis, 14,15 without describing what other clinical data were used to support the diagnosis, despite cPL being reported to be increased in many extrapancreatic diseases, including gastrointestinal, 32‐34 infectious, 11,12 and endocrine disease, 35 among others. In our study, a clinical diagnosis of AP was only made in 8.8% and 14.9% of dogs at admission and during hospitalization, respectively, which is similar to previous studies in dogs that reported concurrent pancreatitis in 15% 2 and 14% 4 of dogs presenting with AKI treated with and without HD, respectively, but somewhat lower than 2 studies describing AP in 22% 3 and 34% 1 of dogs with AKI and AKI/CKD, respectively.…”

“…[9][10][11][12] In particular, increased cPL concentrations or lipase activity have been reported in dogs with kidney disease, [13][14][15] with cPL concentrations ≥400 μg/L in 21/30 dogs with severe AKI in 1 study. 14 However, most studies showed poor correlation between plasma creatinine concentrations and either lipase activity or cPL concentrations. [16][17][18] Increased pancreatic enzyme activity is common in people with kidney failure, and although an increased risk of AP is associated with kidney disease, [19][20][21] hyperenzymemia without clinical evidence of AP is also frequently observed.…”

“…The most common biomarkers for AP currently used in dogs are lipase activity using the 1,2‐ o ‐dilauryl‐rac‐glycero glutaric acid‐(6′‐methylresorufin) ester assay (DGGR‐lipase) and concentrations of canine pancreas‐specific lipase (cPL; Spec cPL, IDEXX laboratories), 6‐8 both of which may be affected by extrapancreatic diseases 9‐12 . In particular, increased cPL concentrations or lipase activity have been reported in dogs with kidney disease, 13‐15 with cPL concentrations ≥400 μg/L in 21/30 dogs with severe AKI in 1 study 14 . However, most studies showed poor correlation between plasma creatinine concentrations and either lipase activity or cPL concentrations 16‐18 …”