Renal failure in acute pancreatitis

Area of Science:

• Nephrology
• Gastroenterology
• Critical Care Medicine

Background:

• Acute renal failure (ARF) can stem from various primary conditions.
• Acute pancreatitis is a recognized, though less common, cause of ARF.
• Understanding the clinical profile and outcomes of ARF secondary to pancreatitis is crucial for patient management.

Purpose of the Study:

• To investigate the incidence and characteristics of acute pancreatitis as a primary cause of acute renal failure.
• To analyze the clinical presentation, laboratory findings, imaging results, and management strategies for these patients.
• To determine the outcomes and mortality associated with acute renal failure secondary to acute pancreatitis.

Main Methods:

• Retrospective analysis of 356 patients with acute renal failure.
• Identification of patients where acute pancreatitis was the primary underlying disease (n=26).
• Review of clinical data, laboratory results, imaging (CT scan, USG abdomen), management interventions, and patient outcomes.

Main Results:

• 26 patients (7.3%) had acute pancreatitis as the primary cause of ARF, predominantly males (65.4%) with a mean age of 35.6 years.
• Common symptoms included epigastric pain/tenderness (100%), nausea/vomiting (73%), and fever (50%). Significant findings included pleural effusion, hemopericardium, shock, pseudocyst, and ARDS.
• Elevated serum amylase (100%), lipase, triglycerides, and blood sugar were noted. Bilateral enlarged kidneys were seen in all on imaging. Peritoneal dialysis was universal, with surgery in 53.8% for severe cases. All recovered from ARF, but 26.9% mortality occurred due to pancreatitis complications.

Conclusions:

• Acute pancreatitis is a significant, albeit uncommon, primary etiology for acute renal failure.
• Patients present with a constellation of gastrointestinal, systemic, and renal symptoms, requiring comprehensive diagnostic and management approaches.
• While ARF is manageable in these cases, mortality is driven by severe pancreatitis complications, highlighting the need for early recognition and intervention.