LITERATURE COLLECTION

Author Title Journal/Edition/Page No.

Royse VL, Jensen DM, Corwin HL., Pancreatic enzymes in chronic renal failure. Arch Intern Med. 1987 Mar;147(3):537-9.

Abstract Serum was obtained from 55 patients, including 43 with stable chronic renal failure (CRF) (28 receiving chronic hemodialysis [CHD] and 15 receiving chronic ambulatory peritoneal dialysis [CAPD]), nine with peritonitis receiving CAPD, and three with pancreatitis receiving CAPD. Total serum amylase activity, lipase activity, isoamylase fractionation, and lipase concentration were used to measure pancreatic enzymes. Amylase activity was increased in 35 of 43 patients with CRF but was greater than threefold elevated in only three. Pancreatic isoamylase activity was greater than 80% in only one patient with CRF but was greater than 80% in all three patients with pancreatitis receiving CAPD. Lipase activity was increased in 26 patients and lipase concentration was elevated in 27. Peritoneal fluid from three patients with pancreatitis receiving CAPD contained high levels of amylase. Serum amylase and lipase are frequently elevated in patients with CRF in the absence of clinical pancreatitis. However, serum amylase activity greater than threefold elevated or the presence of pancreatic enzymes in the peritoneal fluid may suggest coexistent pancreatitis.

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Abstract

Author Title Journal/Edition/Page No.

Anderstam B, Garca-Lpez E, Heimbrger O, Lindholm B Determination of alpha-amylase activity in serum and dialysate from patients using icodextrin-based peritoneal dialysis fluid. Perit Dial Int. 2003;23(2):146.

OBJECTIVE: Low serum activity of alpha-amylase has been reported in peritoneal dialysis (PD) patients following treatment with icodextrin-based peritoneal dialysis fluid (IPDF). However, these results have been questioned because icodextrin interferes with the polysaccharide reagent included in the assay as a substrate for alpha-amylase in the sample. DESIGN: We adapted a routine method using p-nitrophenol maltoheptaoside as substrate for the analysis of total alpha-amylase in serum and dialysate from 27 patients using IPDF. Serum from 12 healthy volunteers and serum and dialysate from 19 PD patients using glucose-based peritoneal dialysis fluid (GPDF) were used as controls. For the PD patients, time on dialysis ranged from 1 to 24 months (mean 5.7 months) and time of exposure to IPDF ranged from 1 to 52 weeks. RESULTS: To test for interference and recovery, and thus to validate the alpha-amylase assay, samples were spiked with IPDF and synthetic alpha-amylase. This revealed that addition of up to 75% IPDF did notinterfere with the assay. Furthermore, alpha-amylase was fully recovered when spiked in serum from patients treated with IPDF. We show that total alpha-amylase activity is considerably lower in the serum of IPDF patients (20.3 +/- 16.5 U/L, p<0.001) than GPDF patients (85.5 +/- 51.7 U/L) and healthy persons (55.1 +/- 13.6 U/L). CONCLUSIONS: We have shown that the IL method (ILTest; Instrumentation Laboratory, Lexington, MA, USA) measures alpha-amylase activity in samples containing icodextrin metabolites. The clinical significance of reduced plasma alpha-amylase activity, as well as the relative importance of pancreatic versus salivary and tissue-bound alpha-amylase, in PD patients using IPDF is not known.

Author Title

Robitaille R, Lafrance JP, Leblanc M Altered laboratory findings associated with end-stage renal disease.

Journal/Edition/Page No. Abstract

Semin Dial. 2006;19(5):373.

Several laboratory parameters can be altered in advanced renal failure. Results may be difficult to interpret and may become misleading and unreliable in such a context. On the other hand, some of the alterations may reflect real abnormalities. Thus sufficient knowledge and careful judgment are required by the clinician. We reviewed different publications related to biochemical anomalies in renal failure and report some of the main findings. The sections are divided as follows: cardiovascular risk factors and markers, inflammation markers, pancreatic and liver function tests, hormones, bone turnover indices and parathyroid hormone assays, tumor markers, carbohydrate metabolism indicators, and others. The information provided should be useful to clinicians involved in the care of renal failure patients.

Author

Title Journal/Edition/Page No.

Lin XZ, Chen TW, Wang SS, Shiesh SC, Tsai YT, Huang TP, Lee SD, Ting SW Pancreatic enzymes in uremic patients with or without dialysis. Clin Biochem. 1988;21(3):189.

Abstract One hundred thirty blood samples from 87 patients with renal failure, but without abdominal pain, were analyzed for blood urea nitrogen (BUN), creatinine, amylase, p-isoamylase, and lipase simultaneously. We found that 74, 78, and 80% of the patients had hyperamylasemia, hyperisoamylasemia, and hyperlipasemia. None had amylase higher than five times the upper limit. A few patients (2.3%) had lipase elevated to more than 10 times the upper limit. No significant change of pancreatic enzyme level was noted as a result of hemodialysis, but a significant amount of amylase was removed from the circulation in patients receiving intermittent peritoneal dialysis. Significantly lower pancreatic enzyme levels were observed in patients with less impairment of renal function. We conclude that elevation of pancreatic enzymes in uremic patients is more frequent and more extensive than most articles indicate, and that the extent of increase is related more to renal function than to the modalities of dialysis the patients received.

Author Title

Collen MJ, Ansher AF, Chapman AB, Mackow RC, Lewis JH Serum amylase in patients with renal insufficiency and renal failure.

Journal/Edition/Page No. Am J Gastroenterol. 1990;85(10):1377.

Abstract Results vary with regard to the upper limits of serum amylase seen in patients with renal failure, and very little has been reported with patients with renal insufficiency not yet requiring dialysis. To determine the level of serum amylase elevation in renal insufficiency and renal failure, we determined serum amylase values in 128 subjects with creatinine clearances less than 90 ml/min. Serum amylase remained in the normal range when creatinine clearance was greater than 50 ml/min, and did not become elevated until creatinine clearance was less than 50 ml/min. The highest serum amylase recorded in the absence of acute pancreatitis was 503 IU/L (normal, less than 128 IU/L). Serum lipase and trypsin values paralleled those for serum amylase; values remained normal when creatinine clearance was greater than 50 ml/min, and were normal or elevated when creatinine clearance was less than 50 ml/min. These results indicate that elevations of serum amylase (i.e., amylase greater than 128 but less than 500 IU/L) in asymptomatic patients with impaired renal function are not evident until creatinine clearances fall below 50 ml/min, and probably do not represent acute pancreatitis.

Author

Title

Giuseppe Montalto, Antonio Carroccio, Vito Sparacino, Domenico Lorello, Daniela Di Martino, Maurizio Soresi, Antonio Galione and Alberto Notarbartolo Pancreatic enzymes in chronic renal failure and transplant patients

Journal/Edition/Page No. Abstract

International Journal of Gastrointestinal Cancer Volume 12, Number 3, 211-217, DOI: 10.1007/BF02924359

The aim of the present study was to determine the frequency and degree of elevated serum levels of Total Amylase (TA), Pancreatic Amylase (PA), and Lipase (L) activity in patients with chronic renal failure (CRF) on conservative therapy; CRP on periodical hemodialysis (HD); in renal transplant (RT) and in a control Group (C). Mean values were significantly higher in all groups than Group C for TA (p < 0.005), PA (p < 0.0001) and L (p < 0.0001). A statistically significant correlation was found between TA and L vs creatininemia values in CRF patients, but only up to a certain level (creatininemia <6 mg%) (p < 0.03 andp < 0.05), above which there was no correlation. The enzyme most frequently over the maximum normal limit was PA, both in the total CRF group (51%), in the hemodialysis patients (65%), and in the RT patients (55%); but only a few patients had values two times higher than the normal limits: 15% in the total CRF, 14% is the hemodialysis, and 10% in the RT groups, respectively. These results suggest that the increase in serum pancreatic enzyme during chronic renal pathology is slight but frequently occurs. It is possible that in these patients together with the renal excretion impairment there could also be some subclinical pancreatic damage; its genesis could also depend on the pharmacological treatment used (diuretics, immunosuppressive drugs) commonly adopted in these pathologies.

Author

PITCHUMONI C. S. , ARGUELLO P. ,AGARWAL N. ,YOO J. ; Acute pancreatitis in chronic renal failure The American journal of gastroenterology, 1996, vol. 91, no12, pp. 2477-2482 (38 ref

Title Journal/Edition/Page No.

Abstract Objective : To estimate the frequency and severity of acute pancreatitis (AP) associated with chronic renal failure (CRF) and to find out whether CRF causes AP. Methods : We studied 532 patients with a first episode of AP during the period of 1982-1994. Twenty-one patients had CRF (endogenous creatinine clearance <15 ml/min); 511 patients without CRF served as controls (nonCRF). AP was diagnosed clinically and by elevation of amylase and lipase (3 times above upper limit of normal). CT or sonographic confirmation of diagnosis was made in all CRF patients. Results : Cause of AP in the non-CRF group (ETOH 48.5%, biliary 32.9%, miscellaneous 18.5%) was significantly different (p < 0.001) from that seen in the CRF group (ETOH 33%, biliary 14.2%, and miscellaneous 52.3%). Incidence of severe AP in the two groups as assessed by >3 Ranson's criteria was 47.6% in the CRF group versus 21% in the non-CRF group (p < 0.005) and by simplified prognostic criteria it was 38 versus 10.3% (p < 0.005), respectively. Overall, CRF patients had more complications compared with non-CRF (66.6 vs. 26.8%, p < 0.005). CRF patients with severe AP had high mortality when stratified by either Ranson's >3 (70 vs. 11.1% p < 0.000) or simplified prognostic criteria >2 (87.5 vs. 20.8%, p < 0.0001). Conclusions : AP in CRF is frequently of unknown cause, suggesting the role of either CRF or other factors. Irrespective of cause, AP in CRF is a serious disease, associated with a high morbidity and mortality.

Author

Morrell Michael Avram

Title Journal/Edition/Page No.

High Prevalence of Pancreatic Disease in Chronic Renal Failure

Nephron 1977;18:68-71 (DOI: 10.1159/000180768)

Abstract

The prevalence of pancreatic disease was determined in 21 autopsied uremic patients who had died during the course of maintenance hemodialysis, as compared with 60 autopsied patients without kidney or pancreatic disease. Histologic criteria of pancreatic disease included. (1) duct ectasia; (2) periductal fibrosis; (3) ductular proliferation; (4) acinar ductalar metaplasia, and (5) interstitial inflammation or fibrosis. Significant pancreatic disease was present in 56% of the uremic patients and only 11.8% of the controls (p < 0.01). Two uremic patients had abscesses in the tail of the pancreas. The clinical significance of the high prevalence of pancreatic pathologic alterations in uremia remains to be assessed.

Author

E. B. Pedersen, A. Brock and H. J. Kornerup Serum Amylase Activity and Renal Amylase Activity Clearance in Patients with Severely Impaired Renal Function and in Patients Treated with Renal Allotransplantation

Title

Journal/Edition/Page No.

Scandinavian Journal of Clinical & Laboratory Investigation,1976, Vol. 36, No. 2 , Pages 137-140

Abstarct

Serum amylase activity was measured in 29 nondialysed patients with severe renal failure, in 24 uraemic patients treated with chronic haemodialysis, and in 29 patients treated with renal allotransplantation. Simultaneous measurement of renal amylase activity clearance (cam) and creatinine clearance (Ccr) was performed in 25 patients with severe renal failure and in 19 transplanted patients. Serum amylase activity was elevated in all three groups. Cam was significantly correlated to Ccr both in the group with severe renal failure and in the transplanted group. Unlike in the group of transplanted patients, the ratio Cam/Ccr was significantly increased in patients with severe impaired renal function. It is concluded that the elevation of serum amylase activity in patients with impaired renal function is primarily due to decreased glomerular filtration rate. The value of CAm/Ccr for diagnosing acute pancreatitis is doubtful in patients with severe renal disease.

Author

Michael D. Levitt, M.D.; Mark Rapoport; And Sidney R. Cooperband, M.D.

10

Title Journal/Edition/Page No.

The Renal Clearance of Amylase in Renal Insufficiency, Acute Pancreatitis, and Macroamylasemia Annals of Internal Medicine, November 1, 1969 vol. 71
no. 5 919-925

Abstract

The renal handling of amylase was studied in patients with renal insufficiency, acute pancreatitis, and macroamylasemia by measuring the rate of amylase clearance (CAm) relative to the rate of creatinine clearance (CCr). In renal insufficiency CAm was decreased in proportion to CCr. In acute pancreatitis, the kidney cleared amylase at a markedly increased rate. The ratio of the amylase clearance rate to the creatinine clearance rate averaged three times normal early in the course of acute pancreatitis, and this elevation could persist after the serum amylase had returned to normal. This increased clearance of amylase makes the urinary amylase a more sensitive indicator of pancreatitis than is the serum measurement. In contrast to pancreatitis, the high serum amylase levels found in patients with macroamylasemia are associated with an extremely low CAm/CCr ratio. These studies suggest that the diagnostic value of amylase measurements may be enhanced if amylase excretion is related to creatinine excretion.

References
1) Royse VL, Jensen DM, Corwin HL, Pancreatic enzymes in chronic renal failure,Arch

Intern Med. 1987 Mar;147(3):537-9.

2) Anderstam B, Garca-Lpez E, Heimbrger O, Lindholm B, Determination of alpha-

amylase activity in serum and dialysate from patients using icodextrin-based peritoneal dialysis fluid., Perit Dial Int. 2003;23(2):146.

3) Robitaille R, Lafrance JP, Leblanc M, Altered laboratory findings associated with endstage renal disease., Semin Dial. 2006;19(5):373.
4) Lin XZ, Chen TW, Wang SS, Shiesh SC, Tsai YT, Huang TP, Lee SD, Ting SW,

Pancreatic enzymes in uremic patients with or without dialysis., Clin Biochem. 1988;21(3):189.
5) Collen MJ, Ansher AF, Chapman AB, Mackow RC, Lewis JH, Serum amylase in patients

with renal insufficiency and renal failure., Am J Gastroenterol. 1990;85(10):1377.

6) Giuseppe Montalto, Antonio Carroccio, Pancreatic enzymes in chronic renal failure and

transplant patients,International Journal of Gastrointestinal Cancer Volume 12, Number 3, 211-217, DOI: 10.1007/BF02924359 7) Pitchumoni C. S. , Arguello P. ,Agarwal N. ,Yoo J. ; Acute pancreatitis in chronic renal failure, The American journal of gastroenterology, 1996, vol. 91, no12, pp. 2477-2482 (38 ref
8) Morrell Michael Avram, High Prevalence of Pancreatic Disease in Chronic Renal

Failure, Nephron 1977;18:68-71 (DOI: 10.1159/000180768)

9) E. B. Pedersen, A. Brock and H. J. Kornerup, Serum Amylase Activity and Renal

Amylase Activity Clearance in Patients with Severely Impaired Renal Function and in Patients Treated with Renal Allotransplantation, Scandinavian Journal of Clinical & Laboratory Investigation,1976, Vol. 36, No. 2 , Pages 137-140.
10)Michael D. Levitt, M.D.; Mark Rapoport; And Sidney R. Cooperband, M.D., The Renal

Clearance

of

Amylase

in

Renal

Insufficiency,

Acute

Pancreatitis,

and

Macroamylasemia, Annals of Internal Medicine, November 1, 1969 vol. 71 no. 5 919-925