Skip to main content

Alterations of exocrine pancreas in end-stage renal disease do they reflect a clinically relevant uremic pancreopathy?

Abstract

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 assess the clinical relevance of the pancreatic alterations that occur in these patients. Twenty-eight healthy subjects served as controls. Initial studies included serum amylase, isoamylase, and lipase assays; fecal chymotrypsin measurement; and abdominal ultrasonography. The amylase, lipase, and chymotrypsin determinations, as well as ultrasound examination, were repeated four years later. None of the patients had clinical evidence of pancreatic disease at entry into the study, but one had had previous attacks of pancreatitis and another developed mild acute pancreatitis one month after entry. Initial mean serum enzyme levels were significantly higher in patients than in controls (amylase, pancreatic isoamylase, and lipase,P<0.001; salivary isoamylaseP<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. Mean 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 years showed no significant difference with respect to the first study. Ultrasonographic changes were rare and mild: one patient had a small cyst in the pancreas head, another, an increase in echogenicity of the gland not related to age; these findings were unchanged at repeat examination. The results demonstrate that the frequent elevations of serum pancreatic enzymes and the rare sonographic changes found in patients undergoing hemodialysis do not generally reflect a relevant pancreopathy. However, the finding of significantly decreased fecal chymotrypsin may indicate the presence of pancreatic dysfunction in end-stage renal disease.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Esker AH, Mujais SK: Uremic exocrine pancreopathy. Int J Artif Organs 10:135–138, 1987

    Google Scholar 

  2. 2.

    Abu-Alfa A, Ivanovich P, Mujais SK: Uremic exocrine pancreopathy. Nephron 48:94–100, 1988

    Google Scholar 

  3. 3.

    Boudailliez B, André JL, Broyer M, Davin JC, Landthaler G, Palcoux JB: Acute pancreatitis in six non-transplanted uraemic children. Pediatr Nephrol 2:431–435, 1988

    Google Scholar 

  4. 4.

    Rutsky EA, Robards M, Van Dyke JA, Rostand SG: Acute pancreatitis in patients with end-stage renal disease without transplantation. Arch Intern Med 146:1741–1745, 1986

    Google Scholar 

  5. 5.

    Baggenstoss AH: The pancreas in uremia: A histopathologic study. Am J Pathol 24:1003–1011, 1948

    Google Scholar 

  6. 6.

    Avram MM: High prevalence of pancreatic disease in chronic renal failure. Nephron 18:68–71, 1977

    Google Scholar 

  7. 7.

    Vaziri ND, Dure-Smith B, Miller R, Mirahmadi M: Pancreatic pathology in chronic dialysis patients—an autopsy study of 78 cases. Nephron 46:347–349, 1987

    Google Scholar 

  8. 8.

    Araki T, Ueda M, Ogawa K, Tsuji T: Histological pancreatitis in end-stage renal disease. Int J Pancreatol 12:263–269 1992

    Google Scholar 

  9. 9.

    Wittich KA, Schmidt H, Scheler F, Creutzfeldt W: Exokrine pankreasfunktion bei chronischer niereninsuffizienz. Verh Dtsch Ges Inn Med 74:1072–1074, 1968

    Google Scholar 

  10. 10.

    Bartos V, Melichar J, Erben J: The function of the exocrine pancreas in chronic renal disease. Digestion 3:33–40, 1970

    Google Scholar 

  11. 11.

    Gerhard VW, Stein G, Bosseckert H, Graupner C, Nosske A: Exkretorische pankreasfunktion bei niereninsuffizienz. Z Inn Med 29:895–899, 1974

    Google Scholar 

  12. 12.

    Otte M, Stahlheber H, Forrell MM, Dobbelstein H, Richert J, Thurmayr R, Thurmayr GR: Exokrine pankreas-funktion bei chronischer niereninsuffizienz. Klin Wochenschr 53:67–72, 1975

    Google Scholar 

  13. 13.

    Poll WM, Werner J, Huber W, Kempmann G, Willig F: Exokrine pankreasfunktion bei chronischer niereninsuffizienz. Z Gastroenterol 17:177–186, 1979

    Google Scholar 

  14. 14.

    Dinoso VP, Murthy SNS, Saris AL, Clearfield HR, Lyons P, Nickey WA, Simonian S: Gastric and pancreatic function in patients with end-stage renal disease. J Clin Gastroenterol 4:321–324, 1982

    Google Scholar 

  15. 15.

    Owyang C, Miller LJ, DiMagno EP, Mitchell JC III, Go VLW: Pancreatic exocrine function in severe human chronic renal failure. Gut 23:357–361, 1982

    Google Scholar 

  16. 16.

    Sachs EF, Hurwitz FJ, Bloch HM, Milne FJ: Pancreatic exocrine hypofunction in the wasting syndrome of end-stage renal disease. Am J Gastroenterol 78:170–173, 1983

    Google Scholar 

  17. 17.

    Moses R, Panebianco P, Dinoso VP, Chey WY, Kostman JR, Clearfield HR, Murthy SNS: Decreased pancreatic bicarbonate responsiveness to graded doses of secretin in end-stage renal disease. Gastroenterology 86:1190, 1984 (abstract)

    Google Scholar 

  18. 18.

    Levitt MD, Ellis C: Serum isoamylase measurements in pancreatitis complicating chronic renal failure. J Lab Clin Med 93:71–77, 1979

    Google Scholar 

  19. 19.

    Royse VL, Jensen DM, Corwin HL: Pancreatic enzymes in chronic renal failure. Arch Intern Med 147:537–539, 1987

    Google Scholar 

  20. 20.

    Bastani B, Mifflin TE, Lovell MA, Westervelt FB, Bruns DE: Serum amylases in chronic and end-stage renal failure: effects of mode of therapy, race, diabetes and peritonitis. Am J Nephrol 7:292–299, 1987

    Google Scholar 

  21. 21.

    Caruana RJ, Altman R, Fowler B, Blansit B, Chaudhary BA, Weinstein RS: Correlates of amylase and lipase levels in chronic dialysis patients. Int J Artif Organs 11:454–458, 1988

    Google Scholar 

  22. 22.

    Hörl WH, Wanner C, Schollmeyer P, Ogawa M: Plasma levels of pancreatic secretory trypsin inhibitor in relation to amylase and lipase in patients with acute and chronic renal failure. Nephron 49:33–38, 1988

    Google Scholar 

  23. 23.

    Fahrenkrug J, Staun-Olsen P, Magid E: Immunoreactive trypsin and pancreatic isoamylase activity in serum of patients with chronic renal failure or hepatic cirrhosis. Clin Chem 27:1655–1657, 1981

    Google Scholar 

  24. 24.

    Araki T, Masatoshi U, Kazuhisa T, Kiyowo K: Pancreatic-type hyperamylasemia in end-stage renal disease. Dig Dis Sci 34:1425–1427, 1989

    Google Scholar 

  25. 25.

    Ventrucci M, Pezzilli R, Garulli L, Liguori L, Moratti R, Melzi d'Eril GV: Clinical evaluation of a new rapid assay for serum lipase determination. Ital J Gastroenterol 26:132–136, 1994

    Google Scholar 

  26. 26.

    Niederau C, Sonnenberg A, Müller JE, Erckenbrecht JF, Scholten T, Fritsch WP: Sonographic measurements of the normal liver, spleen, pancreas and portal vein. Radiology 149:537–540, 1983

    Google Scholar 

  27. 27.

    Geokas MC, Reidelberger R, O'Rourke M, Passaro E, Largman C: Plasma pancreatic trypsinogens in chronic renal failure and after nephrectomy. Am J Physiol 242:G177-G182, 1982

    Google Scholar 

  28. 28.

    Thompson JC, Fender HR, Ramus NI, Villar HV, Rayford PL: Cholecystokinin metabolism in man and dogs. Ann Surg 182:496–504, 1975

    Google Scholar 

  29. 29.

    Curtis PJ, Rayford PL, Thompson JC: Renal extraction of circulating secretin in dogs. Physiologist 18:181, 1975 (abstract)

    Google Scholar 

  30. 30.

    Curtis PJ, Fender HR, Rayford PL, Thompson JC: Catabolism of secretin by the liver and kidney. Surgery 80:259–265, 1976

    Google Scholar 

  31. 31.

    Owyang C, Miller LJ, DiMagno EP, Brennan LA, Go VW: Gastrointestinal hormone profile in renal insufficiency. Mayo Clin Proc 54:769–773, 1979

    Google Scholar 

  32. 32.

    Falcao HA, Wesdorp RIC, Fischer JE: Gastrin levels and gastric acid secretion in anephric patients and in patients with chronic and acute renal failure. Ann Surg Res 18:107–111, 1975

    Google Scholar 

  33. 33.

    Gedde-Dahl D, Flatmark A: Serum gastrin in patients with azotemia. Scand J Urol Nephrol 29(suppl):25–27, 1975

    Google Scholar 

  34. 34.

    Korman MG, Laver MC, Hansky J: Hypergastrinaemia in chronic renal failure. Br Med J 1:209–210, 1972

    Google Scholar 

  35. 35.

    Antonucci F, Vezzadini P, Adorati M, Bonora G, Messa P, Montanaro D, Mioni G: Serum trypsin-like immunoreactivity and secondary hyperparathyroidism in renal failure. Scand J Gastroenterol 15(suppl 62):53–57, 1980

    Google Scholar 

  36. 36.

    Kwan JTC, Almond MK, Beer JC, Noonan K, Evans SJW, Cunningham J: “Pulse” oral calcitriol in uraemic patients: Rapid modification of parathyroid response to calcium. Nephrol Dial Transplant 7:829–834, 1992

    Google Scholar 

  37. 37.

    Ventrucci M, Pezzilli R, Gullo L, Platè L, Sprovieri G, Barbara L: Role of serum pancreatic enzyme assays in diagnosis of pancreatic disease. Dig Dis Sci 34:39–45, 1989

    Google Scholar 

  38. 38.

    Ammann RW, Akovbiantz A, Häcki W, Largiadèr F, Schmid M: Diagnostic value of the fecal chymotrypsin test in pancreatic insufficiency, particularly chronic pancreatitis: correlation with the pancreozymin-secretin test, fecal fat excretion and final clinical diagnosis. Digestion 21:281–289, 1981

    Google Scholar 

  39. 39.

    Cavallini G, Benini L, Brocco G, Riela A, Bovo P, Pederzoli P, Angelini G, Pelle C, Bertelli G, Scuro LA: The fecal chymotrypsin assay in the evaluation of exocrine pancreatic capacity. Comparison with other direct and indirect pancreatic function tests. Pancreas 4:300–304, 1989

    Google Scholar 

  40. 40.

    Dürr HK, Schneider R, Bode C, Bode JC: Fecal chymotrypsin: Study on some characteristics of the enzyme. Digestion 17:396–403, 1978

    Google Scholar 

  41. 41.

    Riedel L, Walker ARP, Segal I, Mohamed AE, Smyth AE, Daya B, Naik I: Limitations of faecal chymotrypsin as a screening test for chronic pancreatitis. Gut 32:321–324, 1991

    Google Scholar 

  42. 42.

    Van Dyke JA, Rutsky EA, Stanley RJ: Acute pancreatitis associated with end-stage renal disease. Radiology 160:403–405, 1986

    Google Scholar 

  43. 43.

    McCarty RL, Ward EM, Charboneau JW, Sheedy II PF, Johnson CD: Imaging of the pancreas.In The Pancreas. Biology, Pathobiology and Disease. VLW Go, EP DiMagno, JD Gardner, E Lebenthal, HA Reber, GA Scheele (eds.) New York, Raven Press, 1993, pp. 1103–1135

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. Ventrucci MD.

Additional information

This study was partially supported by the University and Scientific Technological and Research Ministry in 1993.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ventrucci, M., Campieri, C., Di Stefano, M. et al. Alterations of exocrine pancreas in end-stage renal disease do they reflect a clinically relevant uremic pancreopathy?. Digest Dis Sci 40, 2576–2581 (1995). https://doi.org/10.1007/BF02220444

Download citation

Key Words

  • exocrine pancreatic function
  • hemodialysis
  • pancreatitis
  • renal failure
  • serum pancreatic enzymes
  • ultrasonography