Korean Journal of Nephrology 1992;11(3):222-233.

급성췌장염에 합병된 급성신부전의 임상적 특징

조종태 , 임춘수 , 안규리 , 한진석 , 김성권 , 이정상

Abstract

We analyzed the clinical characteristics of nineteen patients with acute renal failure (ARF) in acute pan- creatitis, all of whom had been admitted to Seoul National University Hospital between Jan. 1980 and Dee. 1990. The following results were obtained. 4.8% of acute pancreatitis patients went into ARF, and 2.1% 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 pan- creatitis 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 (>12mg/dl). The complications included upper GI bleeding (7), shock (6), adult respira- tory distress syndrome (ARDS) (5), pancreatic abscess (4), disseminated intravascular coagulation (3), pancre- atic 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 per- itoneal 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), and un- known (1). In conclusion, we should consider acute pancreatitis as a cause of ARF when the ARF patient has abdominal pain, severe hypocalcemia, hyperuricemia and under- lying disorder such as alcoholism or biliary tract dis- order, and should perform early diagnostic work-up including amylase-creatinine clearance ratio and ade- quate management for the acute pancreatitis and ARF.