ALTERATIONS OF EXOCRINE PANCREAS IN END-STAGE RENAL-DISEASE - DO THEYREFLECT A CLINICALLY RELEVANT UREMIC PANCREOPATHY

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.