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

Abstract

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.

Independent association between low serum amylase and non-alcoholic fatty liver disease in asymptomatic adults: a cross-sectional observational study

“…To exclude subjects with latent conditions likely to adversely affect the results, we excluded those with C reactive protein ≥10.0 mg/l, estimated glomerular filtration rate (eGFR) ≤35 ml/min/1.73 m 2 , serum amylase ≤30 IU/l (the lower fifth percentile in an earlier study12) or ≥200 IU/l based on previous reports,21 22 as well as subjects suspected of having cancer. In the current analysis, to investigate the potential relationship between serum amylase and cardiometabolic features, including NAFLD, we included subjects with a wider range of serum amylase levels than the current reference ranges.…”

Serum Amylases in Chronic and End-Stage Renal Failure: Effects of Mode of Therapy, Race, Diabetes and Peritonitis

“…Unfortunately, serum total amylase, pancreatic amylase, immunoreactive trypsin and lipase activity may be abnormally elevated in CRF [2][3][4][5][6][7][25][26][27][28][29][30], A raised amylase-creatinine clearance ratio, once thought to be diagnostic for acute pancreatitis [11. 12], was subsequently found to be present in other condi tions, such as severe burns, diabetic ketoacidosis [31], severe renal failure [6,7,10,13,14] and in patients on HD [15].…”

Uremic Exocrine Pancreopathy

“…While both forms are cleared by the kidneys, renal clearance of the pancreatic form predominates and this is reflected in the proportion of the two isoenzymes detected in normal urine [21][22][23]; it is thus expected that renal failure will have a differential effect on the levels of the two isoen zymes. Indeed, plasma levels of total amylase are in creased in patients with renal failure [10,II,19,[24][25][26] with a higher proportion of total amylase constituted by the pancreatic isoenzyme [20,[24][25][26][27], Salivary amylase is also increased in uremic subjects but to a lesser degree [24][25][26], These changes obviously complicate the diagno sis of pancreatitis in the setting of renal insufficiency. Lipase Several reports have described elevated circulating levels of the enzyme in uremic subjects [15,[28][29][30][31][32], This elevation has been correlated with the degree of reduc tion in GFR in predialysis subjects [32,33], As expected from the size of the enzyme, hemodialysis has no effect on circulating levels [32], The mechanism of the increase is unclear since the enzyme is not known to be cleared by the kidney [29,34],…”