PANCREATIC ALTERATIONS IN CHRONIC NEPHRITIS WITH AND WITHOUT ABUSE OFANALGESICS

Long-term abuse of analgesics (AA) is a well known cause of chronic in terstitial nephritic. However, a causal association between AA and dam age of the pancreas has been described only occasionally. 30 patients suffering from chronic nephritis (23 from analgesic nephropathy) and w ith habitual analgesic consumption were investigated for morphological changes of the pancreas by X-ray examination and by ultrasound. The e xocrine function was evaluated by measuring the concentration of chymo trypsin in the frees and by the secretin-pancreozymin(caerulein-)test (SPT). The results were compared with those obtained for a group of 15 patients suffering from chronic pyelonephritis (n = 4) or glomerulone phritis (n = 11) without AA and a comparable impairment of kidney func tion. In addition, the results of the SPT were compared to a group of female patients with known chronic pancreatitis. In the group with AA were observed morphological changes of the pancreas in 26.7% (in 16.78 by X-ray examination, in 16.7% by ultrasound and in 6.7% with both me thods), a lower volume of secretion and a significant lower bicarbonat concentration in the duodenal aspirat. Statistically significant diff erences in the enzymatic activity were only detected for amylase. Ther e was no dependance of the pancreatic exocrine function from either th e renal function or the amount of analgesic and the time of analgesic intake. The morphological changes of the pancreas which were found exc lusively in the group with AA as well as the results of the SPT suppor t the hypothesis that AA may be an ethiological (co-)factor in the dev elopment of chronic painless pancreatitis.