[Effect of chronic renal failure and hemodialysis on the pancreas-specific enzyme pattern in the serum]

Amylase concentration in serum is frequently found increased in chronic renal insufficiency without being associated with pancreatic diseases. A prospective study was performed in 71 patients with chronic renal insufficiency undergoing hemodialysis for comparison of different pancreatic enzymes in serum. 7 patients were not considered in this comparative study because of chronic pancreatitis-like-changes in ultrasound. Increased serum concentrations were found for total amylase in 27 patients (42.2%), pancreatic amylase in 26 patients (25.0%), lipase in 50 patients (78.1%), immunoreactive trypsin in 61 patients (95.3%) and for elastase 1 in 7 patients (10.9%). Hemodialysis did not affect any of the investigated pancreatic serum-enzymes. Elastase 1 determination in serum appears superior to the other pancreatic serum-enzymes because of higher specificity, not limited by renal insufficiency. The different serum concentration of elastase 1 and trypsin, which have a similar molecular weight, points towards a completely different clearance mechanism for these enzymes.