Does renal tubular dysfunction account for the enhanced CAm/CCr ratio in acute pancreatitis?

To verify whether renal tubular dysfunction may account for the CAm/CCr enhancement in acute pancreatitis (AP), we have measured the renal excretion of amylase, lysozyme, and gamma-glutamyl-transpeptidase (GGTP) in 22 patients with AP and in 8 with acute tubular necrosis. While the CAm/CCr ratio was elevated in most patients with AP, the CLys/CCr ratio fell within the normal range in 60% of these patients. The subdivision of patients with AP in subgroups with elevated and normal CLys/CCr ratios revealed a mean CAm/CCr not statistically different. Moreover, no correlation was present in AP between amylase vs. both lysozyme and GGTP clearances. These data suggest that tubular dysfunction does occur in some but not in all the patients with AP and seems not to play a major role in the pathogenesis of the increased CAm/CCr ratio in this condition.

[Action of heparin on pulmonary lipids and alveolar surfactant in rabbits]. / Azione dell'eparina sui lipidi polmonari e sul surfactant alveolare di conigli.

The effect of subcutaneous 1000 IU/kg calcic heparin every 12 hr for 7 days on lung lipids and pulmonary surfactant was examined in 10 male rabbits weighing 2.5-3.5 kg. Comparison with an identical control group showed a decrease in phospholipids and lecithins in the lung homogenate extract and in the alveolar liquid bubble stability index. The difference in the means was highly significant (P less than 0.001) for all three parameters.

Amylase to creatine clearance ratio in renal diseases.

In order to assess to what extent glomerular or tubular function is involved in the renal handling of amylase and the lysozyme to creatine clearance ratios (CAm/CCr and CLys/CCr) were evaluated in 22 healthy volunteers and in 71 patients with different renal diseases. In normal controls, the mean CAm/CCr was 2.55 +/-1.54 SD, with an upper normal limit of 5.56. A normal ratio was found in patients with glomerulonephritis, with or without a nephrotic syndrome, and in patients with pyelonephritis. A significantly elevated ratio (P less than 0.001) was instead found in patients with uremia and in patients with uremia and in patients with either chronic or acute tubular damage. The CLus/CCr ratio was elevated in all the groups, except in patients with glomerulonephritis and minimal proteinuria. These results show that in humans, as in animals, the amylase filtered load undergoes partial tubular reabsorption. In renal diseases, an increase of the CAm/CCr is caused by either a marked reduction of functioning nephrons or a severe tubular damage, while the glomerular permeability does not seem to be involved. Some other mechanism is probably involved in the elevation of the CAm/CCr during acute pancreatitis.

RDT with acetate-free bicarbonate buffered dialysis fluid: long-term effects on lipid pattern, acid-base balance and oxygen delivery.

Thirteen uraemic patients with hypertriglyceridaemia were treated for 9 months with acetate-free, bicarbonate containing dialysis fluid. With this treatment more physiological correction of acid-base balance and better tissue oxygenation were obtained. This fact can explain the better tolerance to treatment we have seen. In 9 of these patients triglyceride levels fell significantly on bicarbonate treatment; they shifted back to higher values after return to acetate dialysis. No changes were found in the other 4 patients.