Renal Tubular Dysfunction in Pancreatic Cancer and Chronic Pancreatitis

Abstract

Urinary excretion of alpha-glucosidase (AGL), gamma-glutamyltransferase (GGT) and ribonuclease (RNase), and serum amylase and immunoreactive trypsin (IRT) were determined in 38 control subjects, 48 patients with pancreatic cancer, 77 with chronic pancreatitis and 47 with extrapancreatic diseases in order to ascertain the presence of a renal tubular damage and to investigate its etiology. A significantly increased frequency of pathological results for all urinary enzymes was documented in the various groups of patients as compared to controls. Significant correlations were detected among AGL, GGT and RNase. Considering the subjects as a whole, GGT and RNase excretions correlated with serum IRT and amylase; the two urinary enzymes were found to be higher when jaundice was present. In chronic pancreatic disease enzymuria was related to increased serum pancreatic enzymes; in extrapancreatic diseases it was associated to hyperbilirubinemia. The vast majority of patients with pancreatic cancer and elevated urinary enzymes presented hepatic metastases and/or jaundice. We can conclude that an anatomical and functional tubular impairment is detectable in some patients with chronic pancreatic and extrapancreatic diseases. Tubular damage seems at least in part to be related to pancreatic inflammation and necrosis in chronic pancreatic disease, while jaundice may be found to play an important role in diseases of the hepatobiliary tract. In pancreatic cancer, liver dysfunction (presence of liver metastases and/or extrahepatic cholestasis) also appears to be involved in altering tubular cells.

Urinary Kallikrein Excretion in Chronic Pancreatic Diseases

“…As it is well known that jaundice and liver damage may cause enzymuria, it has been sug gested that pancreatic phlogosis may also alter renal tubular function and cause cellular tubular damage, pos sibly through the release of nephrotoxic substances (pro teolytic enzymes?) [29,30], In a previous study, we dem onstrated that there is a link between the severity of pan creatic inflammation assessed by serum pancreatic en zymes and the degree of tubular dysfunction [31]. How ever, apart from the nature of the damaging factor, renal tubular impairment may cause an increase in the excre tion of both urinary kallikrein and RNase by reducing their reabsorption.…”

Phospholipase A2: Its Usefulness in Laboratory Diagnostics

“…Evidence for this possibility is provided by the fact that in patients with pancreatic disorders renal tubular dysfunction sometimes occurs. 448,449 …”

Ratios of Different Serum Pancreatic Enzymes in the Diagnosis and Staging of Chronic Pancreatitis

“…In patients with CP, however, urinary output of amy lase and IRT are similar due to an impaired renal tubular function that appears, at least in part, to be dependent on the extent of pancreatic damage [20,21], This renal tubu lar dysfunction logically also affects the clearance of lipase, explaining the close correlation that we have found among all three serum pancreatic enzymes in patients with CP. The association between the degrees of renal tubular dysfunction and pancreatic damage could account for the results obtained when the P-amylase/lipase ratio is applied in different stages of CP.…”