Acute pancreatitis in chronic renal failure.

Abstract

OBJECTIVE: To estimate the frequency and severity of acute pancreatitis (AP) associated with chronic renal failure (CRF) and to find out whether CRF causes AP. METHODS: We studied 532 patients with a first episode of AP during the period of 1982-1994. Twenty-one patients had CRF (endogenous creatinine clearance <15 ml/min); 511 patients without CRF served as controls (non-CRF). AP was diagnosed clinically and by elevation of amylase and lipase (3 times above upper limit of normal). CT or sonographic confirmation of diagnosis was made in all CRF patients. RESULTS: Cause of AP in the non-CRF group (ETOH 48.5%, biliary 32.9%, miscellaneous 18.5%) was significantly different (p < 0.001) from that seen in the CRF group (ETOH 33%, biliary 14.2%, and miscellaneous 52.3%). Incidence of severe AP in the two groups as assessed by >3 Ranson's criteria was 47.6% in the CRF group versus 21% in the non-CRF group (p < 0.005) and by simplified prognostic criteria it was 38 versus 10.3% (p < 0.005), respectively. Overall, CRF patients had more complications compared with non-CRF (66.6 vs. 26.8%, p < 0.005). CRF patients with severe AP had high mortality when stratified by either Ranson's >3 (70 vs. 11.1% p < 0.000) or simplified prognostic criteria >2 (87.5 vs. 20.8%, p < 0.0001). CONCLUSIONS: AP in CRF is frequently of unknown cause, suggesting the role of either CRF or other factors. Irrespective of cause, AP in CRF is a serious disease, associated with a high morbidity and mortality.