Diagnostic and prognostic value of CRP in post-ERCP pancreatitis

Acute pancreatitis [AP] is an inflammation of the pancreas secondary to a variety of causes. It is the most common serious complication of endoscopic retrograde cholangiopancreatography [ERCP]. As most ERCP is performed on an outpatient base, early evaluation can allow safe discharge of the majority of patients. The aim of this study was to identify the value of C-reactive protein [CRP] in the diagnosis and prognosis of post-ERCP pancreatitis [PEP]. One hundred patients who were candidate for ERCP examination either diagnostic or therapeutic included in the present study. All patients has been followed-up daily for at least 48 hours after ERCP for symptoms and signs suggestive of post-ERCP pancreatitis and follow-up of post ERCP pancreatitis patients has been done until pancreatic enzymes and CRP became normal. Serum amylase, lipase and CRP were done immediately after ERCP and on 2[nd] and 7[th] day after ERCP. CT abdomen was performed for patients who develop post-ERCP pancreatitis. Patients were divided into group A [GA] which developed post-ERCP pancreatitis [25 patients [25%]] and group B [GB] which had no pancreatitis [75 patients [75%]]. Serum amylase and lipase were significantly higher in GA relative to GB at T[0], T[2], T[7]. Additionally, at T[2] both serum amylase and lipase was more than 3 fold the upper limit of normal in GA. Also data concerned with CRP level at T[0], T[2], T7 revealed a significant increase in GA relative to GB. Data were highly significant at T[2] and T[7]. Out of the 25 cases of Post-ERCP pancreatitis, 17 cases showed CT findings consistent with acute pancreatitis, 13 of them had mild and moderate disease. The remaining 4 cases had severe acute pancreatitis. Since the mean value of CRP at T[7] in GA is still high above upper limit of normal, while serum amylase and lipase were not, and the significant rise in CRP level at T[0], T[2], T[7] in GA was directly correlated to the CT findings. Therefore, these data might suggest the importance of the CRP level as a diagnostic test and also in the assessment of the prognosis of Post-ERCP Pancreatitis, it is cheap, readily available but it is not an early marker

Smoking as a risk factor for renal impairment and proteinuria: a case control study

In this study, the aim is to examine the association between current smoking status and indicators of kidney affection shown by reduced GFR and elevated urine protein/creatinine ratio in a population free of hypertension and diabetes mellitus, The study was carried out on 190 subjects [90 smokers and 100 non smokers]. Both smokers and non smokers were not diabetics nor hypertensives. For each subject serum creatinine [an indicator of GFR] and protein/creatinine ratio in urine [an indicator of proteinuria] were determined. Smokers were classified according to smoking index, which equals number of cigarettes smoked per day multiplied by the number of years of smoking, into: mild smokers [smoking index <200], moderate smokers [smoking index 200-600] and heavy smokers [smoking index >600]. In our study, the socio-demographic characteristic of the study population were matched and there was no statistically significant difference between smokers and non smokers as regards residence, education, occupation and marital status. Males represent 95.6% and females represent 4.4% of the smokers while males represent 97% and females represent 3% of the non smokers. Smokers were more likely to have higher diastolic blood pressure and serum creatinine and lower GFR. In spite of the limited number of the study sample results pointed to the negative effect of smoking on kidney. There was a relation between smoking and renal impairment. A dose-response effect on GFR was shown with lifetime exposure to smoking. The relation between smoking and proteitnuria was less significant. However, one of the few females, who shared our study and was mild smoker, had been with proteinuria. This gives some relation between smoking and proteinuria especially in females. However. longitudinal studies with clear identification of abnormal glucose metabolism and hypertension will be required to provide the missing evidence for causality. The fact that smoking is an important renal risk factor trust be taken into consideration in the management of patients with renal disease. A concerted effort to encourage renal patients to give up smoking. Effective programs aimed at stroking prevention and cessation are highly needed