INCREASED SERUM PANCREATIC-ENZYMES IN UREMIA - RELATION WITH TREATMENT MODALITY AND PANCREATIC INVOLVEMENT

Increased levels of pancreatic enzymes have been reported in patients with renal insufficiency and ascribed either to impaired urinary excre tion or, in a few studies, to the presence of pancreatic damage. In th e present study serum total amylase, pancreatic amylase, and lipase we re evaluated in 63 patients with chronic renal insufficiency (CRF), in 98 patients on hemodialysis (HD), in 28 patients on continuous ambula tory peritoneal dialysis (CAPD), in 23 patients with renal transplanta tion (RT), and in 34 normal volunteers (C). Serum parathyroid hormone and triglyceride levels were also measured in the majority of patients . Ultrasound examination of the pancreas was performed in a select num ber of cases. Mean values of pancreatic enzymes were significantly hig her in all the study groups in comparison with controls, but values ex ceeding three times the upper normal limit were detected only in HD pa tients, who also showed amylase and lipase levels significantly higher than those of CAPD and CRF subjects. Negligible amounts of pancreatic enzymes were detected in peritoneal fluid of CAPD patients. Significa nt correlations were found with serum creatinine in CRF, with parathyr oid hormone in HD and CAPD, and with duration of treatment in HD. No p ancreatic abnormalities were detected by ultrasound. In conclusion, ve ry high levels of pancreatic enzymes are seen mainly in HD patients an d might be related more to the metabolic derangement of long-term dial ysis treatment than to the occurrence of acute pancreatic damage.