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Gupta A, Vuan Z, Balaskas EV, Khanna R, Oreopoulos DG. CAPD and Pancreatitis: No Connection. Perit Dial Int 2020. [DOI: 10.1177/089686089201200308] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.
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Affiliation(s)
- Amit Gupta
- Division of Nephrology, The Toronto Hospital and University of Toronto, Missouri
| | - Zheng Vuan
- Division of Nephrology, The Toronto Hospital and University of Toronto, Missouri
| | - Elias V. Balaskas
- Division of Nephrology, The Toronto Hospital and University of Toronto, Missouri
| | - Ramesh Khanna
- Division of Nephrology, University of Missouri, School of Medicine, Missouri
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Muniraj T, Dang S, Pitchumoni CS. PANCREATITIS OR NOT?--Elevated lipase and amylase in ICU patients. J Crit Care 2015; 30:1370-5. [PMID: 26411523 DOI: 10.1016/j.jcrc.2015.08.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/21/2015] [Accepted: 08/22/2015] [Indexed: 12/26/2022]
Abstract
Elevation in serum levels of pancreatic enzymes (Hyperamylasemia and/or Hyperlipasemia) can occur in any Intensive Care Unit (ICU) patient either as a result of true acute pancreatitis (AP) or as a reflection of a non-pancreatic disease. Although most patients may not have clinical pancreatitis, identifying true acute pancreatitis in the ICU setting may be critical in the presence of associated co-morbid conditions of the disease for which the patient is being managed. With neither amylase nor lipase being specific for pancreatitis, it is important for the clinician to be aware of different causes of hyperamylasemia and hyperlipasemia, especially when clinical diagnosis of pancreatitis is unclear. This review will focus on understanding different non-pancreatic conditions where there is elevation of pancreatitis enzymes and to identify true acute pancreatitis in critically ill patients without typical symptoms.
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Affiliation(s)
| | - Saurabh Dang
- Department of surgery, Mount Sinai Beth Israel Medical center, New York, NY
| | - Capecomorin S Pitchumoni
- Division of Gastroenterology, Hepatology, and Clinical Nutrition, Saint Peters University Hospital, New Brunswick, NJ, USA
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Chen YH, Yang WC, Wang FM, Tarng DC, Chen JY, Ng YY, Wu TH, Lin YP, Lin CC. Risk factors associated with elevated serum pancreatic amylase levels during hemodialysis. Hemodial Int 2011; 15:79-86. [PMID: 21223486 DOI: 10.1111/j.1542-4758.2010.00519.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Elevated levels of serum pancreatic enzymes are frequently observed in hemodialysis (HD) patients. The complex hemodynamic, biochemical, and physiological alterations in uremia were speculated to cause excessive release of pancreatic enzymes beyond decreased renal clearance. However, hemodynamic factors are seldom explored in this aspect. We performed the study to evaluate the association between intradialytic hemodynamic change and elevated serum pancreatic amylase (SPA). Eighty-three prevalent HD patients without any clinical evidence of acute pancreatitis underwent pre-HD and post-HD blood sampling for serum pancreatic enzyme levels. Demographic, biochemical, and hematological data were collected from patient record review. Hemodialysis information including intradialytic blood pressure changes and ultrafiltration (UF) amount were collected and averaged for 1 month before the blood sampling day. Patients with elevated SPA during the HD session had greater mean systolic blood pressure and mean arterial pressure reduction, greater UF volume, greater pre-HD blood urea nitrogen and serum creatinine, higher serum phosphorus, lower pre-HD serum total CO2, and lower left ventricle ejection fraction (LVEF). Using multivariate linear and logistic regression analysis, the independent predictors of elevated SPA were determined to be mean arterial pressure reduction during HD, mean UF amount, pre-HD serum total CO2, and LVEF. Greater blood pressure reduction during HD, greater UF volume, lower pre-HD serum total CO2, and lower LVEF were significantly associated with elevated SPA during HD. This suggests that hemodynamic factors contribute to elevated serum pancreatic enzymes in HD patients.
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Affiliation(s)
- Yen-Hsu Chen
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Wu-Chang Yang
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Feng-Ming Wang
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Yee-Yung Ng
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Tsai-Hun Wu
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Division of Nephrology, Cheng-Hsin General Hospital, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanLo-Sheng Sanatorium Hospital, Taipei, Taiwan
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Abstract
OBJECTIVE To report acute pancreatitis in a patient with non-insulin-dependent diabetes mellitus (NIDDM) receiving exenatide and critically review previous reports. METHODS We describe clinical and laboratory data of a woman with probable exenatide-induced pancreatitis and apply the same criteria to previously published cases. RESULTS A 64-year-old, nonalcoholic woman with NIDDM presented with a 1-month history of epigastric pain beginning 2 days after starting exenatide. Serum lipase concentration was 2700 U/L (reference range, 114-320 U/L), and serum amylase concentration was 131 U/L (reference range, 30-110 U/L). Liver function test results, lipid profile, and serum creatinine concentration were normal. Abdominal computed tomography (CT) showed changes consistent with pancreatitis, and the gallbladder was absent. Exenatide was discontinued. Conservative therapy resulted in rapid resolution of symptoms, normal lipase concentration (151 U/L), and normal findings from CT of the pancreas 90 days later. The US Food and Drug Administration has reported 36 cases of presumed pancreatitis associated with exenatide. However, none of the selection criteria were specified, two-thirds of the patients did not have CT, and 90% had at least 1 other risk factor for acute pancreatitis. A single published case report of exenatide-induced pancreatitis contains no description of the pancreas on abdominal CT, does not mention alcohol use, and does not report normal lipase values. CONCLUSIONS This is the most thoroughly documented example of probable exenatide-induced pancreatitis. In any diabetic patient with acute pancreatitis, exenatide must be ruled out as the cause and its use discontinued.
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Affiliation(s)
- Walaa A Ayoub
- Department of Internal Medicine, Fairview General Hospital, Cleveland Clinic Health System, Westlake, Ohio 44145, USA.
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Chen CC, Wang SS, Chen TW, Jap TS, Chen SJ, Jeng FS, Lee SD. Serum procarboxypeptidase B, amylase and lipase in chronic renal failure. J Gastroenterol Hepatol 1996; 11:496-9. [PMID: 8743924 DOI: 10.1111/j.1440-1746.1996.tb00297.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Procarboxypeptidase B (human pancreas-specific protein) has been reported to be a good serum marker for the diagnosis of acute pancreatitis. The current study was conducted in order to evaluate the frequency and degree of elevated serum levels of procarboxypeptidase B in chronic renal failure and their correlations with serum levels of amylase, lipase and renal function tests. Blood samples were taken from 84 asymptomatic patients with chronic renal failure, including 34 patients with periodical haemodialysis and 50 patients without haemodialysis. Serum levels of procarboxypeptidase B, amylase, lipase, creatinine and blood urea nitrogen were measured. Serum levels of procarboxypeptidase B in 84 patients were 63.4 +/- 5.5 micrograms/L significantly greater than the figure of 29.6 +/- 1.6 micrograms/L in healthy adults in our previous report (P < 0.0001). There was a significant difference in serum levels of PCPB between patients with and without haemodialysis (78.0 +/- 9.4 vs 53.6 +/- 6.3 micrograms/L; P < 0.01). The frequencies of elevated serum levels of procarboxypeptidase B, amylase and lipase greater than upper normal limits were 27.4, 35.7 and 26.2%, respectively. The frequencies of elevated PCPB in patients with and without haemodialysis were 38.2 and 20%, respectively. Only one patient had a serum procarboxypeptidase B level greater than three-fold the upper normal limit. A significant correlation was found between procarboxypeptidase B and lipase (r = 0.785; P < 0.0001). No significant correlation was noted between procarboxypeptidase B vs amylase or renal function tests. In conclusion, in patients with chronic renal failure, the elevation of serum procarboxypeptidase B is as common as the elevations of other pancreatic enzymes.
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Affiliation(s)
- C C Chen
- Department of Medicine, Veterans General Hospital-Taipe, National Yang-Ming University, Taiwan, ROC
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Dardamanis MA, Elisaf MS, Vasakos SA, Tsianos EV, Siamopoulos KC. alpha-Amylase and isoamylase levels in renal transplant recipients compared to uremic patients. Ren Fail 1995; 17:715-9. [PMID: 8771244 DOI: 10.3109/08860229509037639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Hyperamylasemia is a common finding in chronic renal failure (CRF) patients. The present study was designed to evaluate the frequency, the type, and the hyperamylasemia levels in renal transplant recipients (RTR) compared to patients with renal failure with or without replacement of renal function. One hundred and forty-one subjects [42 with varying degree of renal insufficiency (group A), 74 on hemodialysis (group B), and 25 RTR (group C)] and 47 normal individuals were studied. Total serum alpha-amylase (Ta) as well as pancreatic (Pa) and salivary (Sa) types of serum isoamylases were elevated in all groups when compared to the levels found in normal subjects. A remarkable proportion of patients belonging to groups A and B had Ta as well as Pa levels over three times the upper normal limits. On the contrary, no RTR had such increased levels of both Ta and isoamylases. A statistically significant correlation was found between Ta, Pa, and Sa and serum creatinine in RTR. However, no statistically significant correlation was found between urine amylases and serum creatinine or between urine and serum levels in all amylases in this group. In conclusion, serum amylase levels are increased in RTR. However, no subject in this group had amylase and isoamylase values more than three times the upper normal limits, which was a common finding in the other groups of patients.
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Affiliation(s)
- M A Dardamanis
- Department of Internal Medicine School of Medicine University of Ioannina, Greece
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Tsianos EV, Dardamanis MA, Elisaf M, Vasakos S, Siamopoulos KC. The value of alpha-amylase and isoamylase determination in chronic renal failure patients. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1994; 15:105-11. [PMID: 8071568 DOI: 10.1007/bf02924660] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Hyperamylasemia is a common finding in chronic renal failure (CRF) patients. It has been suggested that the diagnosis of acute pancreatitis in these patients is confirmed when serum amylase activities are greater than three times the upper normal limits. In order to evaluate the frequency, the type, and the hyperamylasemia levels in patients with various degree of chronic renal failure, the total serum amylase (Ta), the pancreatic (Pa) and salivary (Sa) types of serum isoamylases, as well as the urine isoamylases (Tu, Pu, Su, respectively) have been determined by the Phadebas method. Moreover, the levels of serum electrolytes and triglycerides were determined in order to study any relationship between serum electrolytes as well as triglycerides and alpha-amylase activities. We studied 102 patients of whom 33 (group A) had CRF with serum creatinine levels 8.5 +/- 3.1 mg/dL (mean +/- SD), 59 (group B) were receiving chronic hemodialysis, and 10 (group C) were on continuous ambulatory peritoneal dialysis as well as 47 normal individuals. None of the subjects studied had any clinical manifestation of acute pancreatitis. Our results showed that the Ta, Pa and Sa levels of groups A, B, and C were significantly elevated compared to normal subjects. Eighteen patients had Pa activities greater than three times the upper normal limits. In the present study, no relationship between serum electrolytes as well as triglycerides and alpha-amylases was found. In conclusion, hyperamylasemia was a much more common finding in CRF patients than previously reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E V Tsianos
- Department of Internal Medicine, School of Medicine, University of Ioannina, Greece
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Chen CC, Wang SS, Chao Y, Chen SJ, Lee SD, Wu SL, Jeng FS, Lo KJ. Serum pancreas-specific protein in acute pancreatitis. Its clinical utility in comparison with serum amylase. Scand J Gastroenterol 1994; 29:87-90. [PMID: 7510410 DOI: 10.3109/00365529409090443] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To compare the clinical utility of serum pancreas-specific protein and serum amylase in the diagnosis of acute pancreatitis, the study was conducted in 134 normal subjects and 70 patients (36 with acute pancreatitis and 34 with other acute abdominal diseases as control group). The serum level of pancreas-specific protein in 134 healthy adults was 29.6 +/- 1.6 micrograms/l, with 95% within 7.3-67.2 micrograms/l. The upper reference limit was set at 70 micrograms/l. Serum levels of pancreas-specific protein and amylase within 12 h of arrival were significantly higher in patients with acute pancreatitis than in the control group (647.3 +/- 79.3 versus 33.8 +/- 4.8 micrograms/l (p < 0.0001) and 2536 +/- 344 versus 175 +/- 35 IU/l (p < 0.0001)). No significant difference in the levels of pancreas-specific protein was noted between biliary and alcoholic pancreatitis or between severe and mild attacks. The sensitivity, specificity, and accuracy of diagnosing acute pancreatitis were 100%, 94.1%, and 97.1% with serum pancreas-specific protein > 70 micrograms/l and 97.2%, 91.2%, and 94.3% with serum amylase > 360 IU/l. The result demonstrated that pancreas-specific protein may be a good serum marker in the diagnosis of acute pancreatitis.
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Affiliation(s)
- C C Chen
- Dept. of Medicine, Veterans General Hospital, Taipei, Taiwan
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