Amylase/Creatinine Clearance Ratio and Tubular Proteinuria in Acute Pancreatitis

Lankisch, P.G.; Wolfrum, D. I.; Koop, H.; Winckler, K.

doi:10.1159/000198397

Cited by 16 publications

(4 citation statements)

References 13 publications

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“…This finding of an increased amylase/creatinine clearance ratio in some patients with chronic renal insufficiency agrees with the results of Morton et al (1976) and Lankisch et al (1977). A high amylase/ creatinine clearance ratio has also been reported in severe renal failure (GFR less than 25 ml/min) by Pedersen et al (1976).…”

Section: Discussionsupporting

confidence: 92%

“…Some authors have reported that the ratio Cam/Ccr remains normal in renal insufficiency (Blainey and Northam, 1967;Levitt et al, 1969) and is increased in the presence of pancreatitis (Mulhausen et al, 1969;Drieling et al 1974;Warshaw and Fuller, 1975). In contrast, recent, studies (Morton et al, 1976;Lankisch et al, 1977) have found raised Cam/Ccr ratios in patients with chronic renal failure without accompanying pancreatitis. These studies measured the clearance of total (T) amylase.…”

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confidence: 99%

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Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.

Keogh¹,

McGeeney²,

Drury³

et al. 1978

Gut

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SUMMARY Pancreatic and salivary amylase/creatinine clearance ratios in patients with various degrees of renal impairment were compared with those obtained for control subjects. In chronic renal insufficiency (mean GFR 30 ml/min ± 15 SD; n = 13) the clearance ratios for pancreatic (mean 3X5 + 1X85 SD) and salivary (mean 2.3 + 1-3 SD) amylase were significantly higher (p < 0 05) than those in controls. Corresponding control values (n = 26) were 2-64 + 0-86 (pancreatic) and 1 64 + 0 95 (salivary). Three patients showed values above the normal limit. In the diabetic group (mean GFR 41 ml/min + 22 SD; n = 10) salivary amylase/creatinine clearance ratios (mean 2-36 + 1-55 SD) were significantly higher than in controls (p < 0 05). Three patients showed raised values. Pancreatic amylase clearance was raised in only one of these patients. Three patients with terminal disease (mean GFR 1Oml/min) showed markedly raised (two-to threefold) clearance ratios for both salivary and pancreatic amylase. Of a total of 26 patients, eight had increased total amylase/creatinine clearance ratios. Pancreatic amylase/creatinine clearance was increased in seven patients, while nine patients showed raised salivary amylase/creatinine ratios. Patients with raised clearance ratios did not have clinical evidence of pancreatitis. We suggest that, in the presence of impaired renal function, a high amylase/creatinine clearance ratio need not be indicative of pancreatic disease.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.

Keogh¹,

McGeeney²,

Drury³

et al. 1978

Gut

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“…Fur thermore, fractional trypsin clearance has been shown to be abnormal in a number of patients with acute and chronic pancreatitis and pancreatic cancer [5,6]. Tubular dysfunction has been demonstrated to be an important factor in determining an altered clearance of both en zymes [7][8][9][10][11][12]. Increased urinary excretion of amylase and immunoreactive trypsin is accompanied by an elevation of one or more indices of tubular impairment.…”

Section: Introductionmentioning

confidence: 99%

Renal Tubular Dysfunction in Pancreatic Cancer and Chronic Pancreatitis

Fabris

Basso²,

Favero³

et al. 1989

Nephron

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Urinary excretion of alpha-glucosidase (AGL), gamma-glutamyltransferase (GGT) and ribonuclease (RNase), and serum amylase and immunoreactive trypsin (IRT) were determined in 38 control subjects, 48 patients with pancreatic cancer, 77 with chronic pancreatitis and 47 with extrapancreatic diseases in order to ascertain the presence of a renal tubular damage and to investigate its etiology. A significantly increased frequency of pathological results for all urinary enzymes was documented in the various groups of patients as compared to controls. Significant correlations were detected among AGL, GGT and RNase. Considering the subjects as a whole, GGT and RNase excretions correlated with serum IRT and amylase; the two urinary enzymes were found to be higher when jaundice was present. In chronic pancreatic disease enzymuria was related to increased serum pancreatic enzymes; in extrapancreatic diseases it was associated to hyperbilirubinemia. The vast majority of patients with pancreatic cancer and elevated urinary enzymes presented hepatic metastases and/or jaundice. We can conclude that an anatomical and functional tubular impairment is detectable in some patients with chronic pancreatic and extrapancreatic diseases. Tubular damage seems at least in part to be related to pancreatic inflammation and necrosis in chronic pancreatic disease, while jaundice may be found to play an important role in diseases of the hepatobiliary tract. In pancreatic cancer, liver dysfunction (presence of liver metastases and/or extrahepatic cholestasis) also appears to be involved in altering tubular cells.

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“…However, studies in pri mates failed to reveal any appreciable tubular reabsorption of amylase [9], and there is ac cumulating evidence that the tubular pro cessing of amylase differs largely from those of other proteins [2,14,17,27], Recently we have shown that serum amy lase and ACCR increased with advancing age [7]. In the following study we have further analyzed our data and tried to define whether the enhancement of ACCR was of glomerular or tubular origin.…”

mentioning

confidence: 99%

Kidney Ageing and Renal Excretion of Amylase

Brohée¹,

Rondelez²,

Bain³

et al. 1982

Gerontology

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In a cross-sectional study, the amylase to creatinine clearance ratio (ACCR) was determined in 180 patients, age range 18–93 years. An inverse correlation was found between ACCR and creatinine clearance (r = ––0.40, p < 0.001) in keeping with the known inverse relationship between the sieving fraction of macromolecules and the glomerular filtration rate. The fractional clearance of amylase was not significantly affected by amylasemia nor by age when the creatinine clearance was also considered in a multiple regression analysis. No increase in ACCR was observed in patients with low molecular weight proteinuria or with induced urine dilution. The authors assume that the tubular reabsorption of amylase is minimal and that the enhancement of ACCR in the elderly mainly reflects modifications in the glomerular filtration dynamics.

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Amylase/Creatinine Clearance Ratio and Tubular Proteinuria in Acute Pancreatitis

Cited by 16 publications

References 13 publications

Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.

Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.

Renal Tubular Dysfunction in Pancreatic Cancer and Chronic Pancreatitis

Kidney Ageing and Renal Excretion of Amylase

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