We analyzed the clinical characteristics of nineteen patients with acute renal failure (ARF) in acute pancreatitis, all of whom had been admitted to Seoul National University Hospital between Jan. 1980 and Dec. 1990.
@ES The following results were obtained.
@EN 4.8% of acute pancreatitis patients went into ARF, and 2.15 of ARF patients had acute pancreatitis. The nineteen patients ranged in age from 18 to 75 years old (43±15; mean ± SD). The female to male ratio was 6:13. The underlying disorders
were
alcoholism (7), biliary tract disorder (6), abdominal trauma (3), hyperlipidemia (1). Immunosuppressive agent after kidney transplant (1) and unknown (1). Epigastric pain was present in all patients. The peak serum amylase level was 497(±188)
U/dl,
FEamyl(fractional excretion of amylase) 9.9±5.5%. In all but one of the nineteen patients, the ARF was oliguric. The time between the onset of acute pancreatitis and oliguria was 1.9(±1.6) days. The duration of oliguria was 6.0 (±4.0) days,
with
a
peak serum creatinine of 10.2(±5.5) mg/dl. There were 5 patients of severe hypocalcemia (<7.0 mg/dl) and 11 patients of severe hyperuricemia(>12 mg/dl) .The complications included upper GI bleeding (7), shock (6), adult respiratory distress
syndrome
(ARDS) (5), pancreatic abscess (4) disseminated intravascular coagulation (3), pancreatic pseudocyst (2), and intraperitoneal hemorrhage (2), surgery was performed in four patients; there was one death among the two patients with incision to
drain
the
pancreatic abscess. And two deaths among the two patients having explorative laparatomy. Dialysis was performed in ten patients: the one patient having peritoneal dialysis died, and three deaths occurred among the eight patients having
hemodialysis. The
mortality of ARF in acute pancreatitis was 47%. The possible causes of deaths were sepsis (3). Hemorrhage (2), shock (1), ARDS(1), endotracheal tube malfunction (1) endotracheal tube malfunction (1), and unknown(1).
In conclusion. We should consider acute pancreatitis as a cause of ARF when the ARF patient has badominal pain. Severe hypocalcemia. Hyperuricemia and underlying disorder such as alcoholism or biliary tract disorder and should perform early
diagnostic
work-up including amylase-creatinine clearance ratio ad adequate management for the acute pancreatitis and ARF.
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