M. Ventrucci et al., ALTERATIONS OF EXOCRINE PANCREAS IN END-STAGE RENAL-DISEASE - DO THEYREFLECT A CLINICALLY RELEVANT UREMIC PANCREOPATHY, Digestive diseases and sciences, 40(12), 1995, pp. 2576-2581
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 ass
ess the clinical relevance of the pancreatic alterations that occur in
these patients. Twenty-eight healthy subjects served as controls, Ini
tial studies included serum amylase, isoamylase, and lipase assays; fe
cal chymotrypsin measurement; and abdominal ultrasonography. The amyla
se, lipase, and chymotrypsin determinations, as well as ultrasound exa
mination, were repeated four years later. None of the patients had cli
nical evidence of pancreatic disease at entry into the study, but one
had had previous attacks of pancreatitis and another developed mild ac
ute pancreatitis one month after entry. Initial mean serum enzyme leve
ls were significantly higher in patients than in controls (amylase, pa
ncreatic 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, M
ean 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 year
s showed no significant difference with respect to the first study. Ul
trasonographic changes were rare and mild: one patient had a small cys
t in the pancreas head, another, an increase in echogenicity of the gl
and not related to age; these findings were unchanged at repeat examin
ation. The results demonstrate that the frequent elevations of serum p
ancreatic enzymes and the rare sonographic changes found in patients u
ndergoing hemodialysis do not generally reflect a relevant pancreopath
y. However, the finding of significantly decreased fecal chymotrypsin
may indicate the presence of pancreatic dysfunction in end-stage renal
disease.