Acute pancreatitis in chronic renal failure.

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.