Amylase-creatinine Clearance Ratio Research Articles

Transient Macroamylasemia in a Severely Multiple-Handicapped Child Following the Development of Acute Bronchitis

Macroamylasemia is a condition of elevated serum amylase levels in which normal serum amylase form a complex with high molecular weight proteins such as immunoglobulins. This is a case report on a patient with macroamylasemia following acute asthmatic bronchitis. A 5-year-old male with cerebral palsy and developmental retardation was admitted to our hospital because of high fever and severe cough. Treatment of the respiratory symptoms provided symptomatic improvement, but the serum amylase levels became suddenly elevated. Although acute pancreatitis associated with respiratory infection was initially suspected, a predominant salivary isoamylase, normal serum lipase level, low urine amylase level, and low amylase-creatinine clearance ratio (ACCR) (0.58%) indicated macroamylasemia. The serum amylase level decreased, and the ACCR increased within normal range 2 weeks after discharge. Both of these indicators have been within normal range over the past year. Transient macroamylasemia can be misdiagnosed as acute pancreatitis, especially in a severely multiple-handicapped child who is unable to complain. The ACCR is useful in the diagnosis of macroamylasemia.

Urinary amylase / urinary creatinine ratio (uAm/uCr) - a less-invasive parameter for management of hyperamylasemia

BackgroundThe serum level of amylase (sAm) is commonly used as a biochemical marker for diagnosis and management of pancreatic disorders. However, the use of the urine level of amylase (uAm) is limited in practice, because the diagnostic ability of uAm is inferior to that of sAm. In the present study, the possible concordance of uAm-rerated parameters with sAm was investigated, and evaluate the usefulness of uAm for management of hyperamylasemia.MethodsFrom June 1995 to October 2009, 804 samples of both urine and blood were collected from 128 patients in order to measure the serum level of amylase (sAm) and the urine level of amylase (uAm) and creatinine (uCr). Concordance of parameters using uAm compared to sAm was assessed. Parameters used were uAm, amylase creatinine clearance ratio (ACCR), and the ratio of uAm to uCr (uAm/uCr).ResultsuAm/uCr had the best correlation with sAm (r = 0.779, p < 0.001) compared to uAm (r = 0.620, p < 0.001) and to ACCR (r = 0.374, p < 0.001), when sAm was over the standard level. The area under the receiver operating characteristic curve of uAm/uCr (0.884) was significantly higher than that of uAm (0.766) and of ACCR (0.666) (p < 0.001 for each). The cutoff value of uAm/uCr was 569.8, with a sensitivity of 81.0% and a specificity of 83.1%.ConclusionsThe uAm/uCr ratio correlated with sAm, and may be an alternative to sAm for prediction of hyperamylasemia. Use of urine samples results in a decreased need for blood sampling, which is especially beneficial in pediatric patients.

Overlapping Presence of Macroamylasemia and Hyperamylasemia in Acute Pancreatitis

Overlapping Presence of Macroamylasemia and Hyperamylasemia in Acute Pancreatitis

Clinical and Laboratory Investigation of Experimental Acute Pancreatitis in the Cat

The main objective of this study is the serial evaluation of clinical and laboratory changes in cats with experimentally-induced acute pancreatitis (AP). A total of 16 clinically healthy young adult DSH cats were included in the study. Acute pancreatitis was induced in 10 (AP group) by infusing oleic acid into the pancreatic duct, while the other 6 cats served as sham-operated controls (C group). Depression or lethargy, anorexia, abdominal pain, and a palpable mass in the anterior abdomen were the main clinical findings in cats of the AP group. Laboratory data revealed non-regenerative anaemia, mild hypoalbuminaemia, transient hyperglycaemia, and hypertriglyceridaemia. Serum lipase activity, feline trypsin-like immunoreactivity (fTLI) concentration, and feline pancreatic lipase immunoreactivity (fPLI) concentration increased significantly within the first 24 hours after the infusion of oleic acid, with time-dependent positive correlation. In both group of cats urine amylase-creatinine ratio and amylase-creatinine clearance ratio were increased. In cats of the AP group, abdominal ultrasonography revealed a hypoechogenic and enlarged pancreas, along with peripancreatic fluid accumulation. Peritoneal effusion was consistent with a sterile exudate, with higher lipase but lower amylase activities when compared to their serum counterparts in all AP group cats. The induction of AP was confirmed by pancreatic histopathology. AP is characterized by vague symptomatology. Increases in serum fTLI and fPLI concentrations occur early in cats with pancreatitis. In general the two analytes run a parallel course, but fPLI may be increased longer than fTLI. The measurement of lipase activity in the peritoneal fluid could be considered diagnostic.

Acute porphyria presenting with hyperamylasemia

An elevation of serum amylase and lipase has not been reported previously to occur with porphyria. In this report, we describe a patient who presented with the clinical and laboratory picture of pancreatitis: elevated amylase, lipase, amylase-creatinine clearance ratio, and with abdominal pain. Only after extensive evaluation, was the patient found to have porphyria. On two separate occasions, with hematin therapy, her serum amylase decreased, as did her clinical symptoms of porphyria and her urinary quantitative porphyrins. This suggests an association between elevation of the serum amylase and lipase with acute porphyria. Moreover, this association can lead to delay in establishing the diagnosis of acute porphyria.

A case of Gilbert’s syndrome combined with macroamylasemia

A 30-year-old Japanese male, who had no remarkable family history, visited our hospital with a complaint of abdominal pain, and unconjugated hyperbilirubinemia and hyperamylasemia were observed. He showed negative hemolysis tests, positive nicotinic acid test, low hepatic bilirubin UDP-glucuronyltransferase activity, decreased bilirubin diglucuronide and increased bilirubin monoglucuronide in bile, and a decrease in serum bilirubin after phenobarbital administration. He also showed high serum amylase level, low urine amylase level, and low amylase-creatinine clearance ratio. Gel filtration of serum with Sephadex G-200 revealed the existence of macroamylase. Countercurrent immunoelectrophoresis proved binding of serum amylase to lambda type IgA. From these results, the case was diagnosed as Gilbert's syndrome combined with macroamylasemia.

Amylase-Creatinine Clearance Ratio: A Simple Test to Predict Gentamicin Nephrotoxicity

• The initial target of aminoglycoside nephrotoxicity is the proximal tubule. Yet, no simple test is available to predict such toxicity. Taking advantage of the fact that amylase is filtered in the glomerulus and reabsorbed by the proximal tubules, we prospectively examined in 23 patients if changes in renal amylase creatinine clearance ratio (ACCR) can predict gentamicin nephrotoxicity. Eighteen of these patients had an initial creatinine clearance (rCcr) above 30 mL/min. Eleven of them (group A) had an ACCR above 3.5% (control 3% ±1.03%) and all exhibited an average reduction of 32.2%±11.6% in rCcr following one week of gentamicin therapy. In contrast, only one of seven patients (group B) with an initial ACCR below 3.5% had a reduction, albeit transient, in rCcr. During gentamicin therapy, group A patients had a further increase in ACCR which was proportional to the reduction observed in rCcr (r= -.54). Our preliminary data suggest that ACCR may prove a simple and possibly a reliable predictor of kidney function deterioration during gentamicin therapy in patients with rCcr above 30 mL/mi n: patients with pretherapy ACCR above 3.5% may exhibit a deterioration in the creatinine clearance during the first week of therapy. For patients with pretherapy renal failure (rCcr ( Arch Intern Med 1988;148:1093-1096)

Amylase-creatinine clearance ratio. A simple test to predict gentamicin nephrotoxicity

The initial target of aminoglycoside nephrotoxicity is the proximal tubule. Yet, no simple test is available to predict such toxicity. Taking advantage of the fact that amylase is filtered in the glomerulus and reabsorbed by the proximal tubules, we prospectively examined in 23 patients if changes in renal amylase creatinine clearance ratio (ACCR) can predict gentamicin nephrotoxicity. Eighteen of these patients had an initial creatinine clearance (rCcr) above 30 mL/min. Eleven of them (group A) had an ACCR above 3.5% (control 3% +/- 1.03%) and all exhibited an average reduction of 32.2% +/- 11.6% in rCcr following one week of gentamicin therapy. In contrast, only one of seven patients (group B) with an initial ACCR below 3.5% had a reduction, albeit transient, in rCcr. During gentamicin therapy, group A patients had a further increase in ACCR which was proportional to the reduction observed in rCcr (r = -.54). Our preliminary data suggest that ACCR may prove a simple and possibly a reliable predictor of kidney function deterioration during gentamicin therapy in patients with rCcr above 30 mL/min: patients with pretherapy ACCR above 3.5% may exhibit a deterioration in the creatinine clearance during the first week of therapy. For patients with pretherapy renal failure (rCcr less than 30 mL/min) the creatinine levels (but not the ACCR) seem to retain their significance in predicting and monitoring further renal function deterioration during aminoglycoside therapy.

Amylase—Creatinine Clearance Ratio

• The initial target of aminoglycoside nephrotoxicity is the proximal tubule. Yet, no simple test is available to predict such toxicity. Taking advantage of the fact that amylase is filtered in the glomerulus and reabsorbed by the proximal tubules, we prospectively examined in 23 patients if changes in renal amylase creatinine clearance ratio (ACCR) can predict gentamicin nephrotoxicity. Eighteen of these patients had an initial creatinine clearance (rCcr) above 30 mL/min. Eleven of them (group A) had an ACCR above 3.5% (control 3% ±1.03%) and all exhibited an average reduction of 32.2%±11.6% in rCcr following one week of gentamicin therapy. In contrast, only one of seven patients (group B) with an initial ACCR below 3.5% had a reduction, albeit transient, in rCcr. During gentamicin therapy, group A patients had a further increase in ACCR which was proportional to the reduction observed in rCcr (r= -.54). Our preliminary data suggest that ACCR may prove a simple and possibly a reliable predictor of kidney function deterioration during gentamicin therapy<i>in patients with rCcr above 30 mL/mi</i>n: patients with pretherapy ACCR above 3.5% may exhibit a deterioration in the creatinine clearance during the first week of therapy. For patients with pretherapy renal failure (rCcr&lt;30 mL/min) the creatinine levels (but not the ACCR) seem to retain their significance in predicting and monitoring further renal function deterioration during aminoglycoside therapy. (<i>Arch Intern Med</i>1988;148:1093-1096)

SIGNIFICANCE OF SERIAL MEASUREMENTS OF ACCR IN THE EARLY DIAGNOSIS OF POSTOPERATIVE PANCREATITIS

We measured postoperative amylase-creatinine clearance ratio (ACCR) and amylase isoenzymes, and evaluated their clinical significance in the early diagnosis of postoperative pancreatitis. It was shown that in cases with perforated duodenal ulcer, serum amylase was not always elevated. Thus, the leakage of pancreatic juice into the peritoneal cavity alone cannot be held responsible for an elevated level of serum pancreatic amylase, i.e., damage of the pancreatic exocrine glands should be considered. Similarly, postoperative patients with elevated serum pancreatic amylase, although suspected of stomal insufficiency, may suffer from acute pancreatitis. We report here two interesting cases with normal serum amylase but abnormal ACCR postoperatively. Acute pancreatitis was found to develop subsequently in these two patients. As a result, it is suggested that prolonged ab-normal ACCR may predict the possibility of postoperative pancreatitis. As ACCR is associated with renal tubular function, increased ACCR is not specific to pancreatitis. However, ACCR is sensitive to pancreatitis. We concluded that serial measurements of ACCR and amylase isoenzymes are helpful in the early diagnosis of postoperative pancreatitis.

Effect of Dextran 40 and aprotinin on experimental acute pancreatitis

This study examines and compares the prophylactic role of aprotinin and Dextran 40 in acute pancreatitis. Experimental acute pancreatitis was induced in 70 male Wistar rats using the closed-duodenal-loop technique. The rats were randomly divided into four groups; sham operation, untreated acute pancreatitis, and therapy with aprotinin or Dextran 40. Samples of blood and urine were collected at the beginning and at the end of the 24-hr period for measurement of amylase and creatinine which allowed calculation of the amylase-creatinine clearance ratio (ACCR). Mortality in the aprotinin group was the same as the untreated rats (20%). Dextran 40 therapy was associated with a lower mortality rate (6.7%). Light microscopic examination confirmed that the histologic changes of acute pancreatitis were less severe in both the aprotinin- and Dextran 40-treated rats. The ACCR was elevated after Dextran 40 therapy, which was due mainly to high urinary amylase levels. These results suggest that Dextran 40 may have a prophylactic role in acute experimental pancreatitis but again emphasizes the high false-positive rate of the ACCR determination.

Chronic hyperamylasemia and chronic pelvic inflammatory disease.

A 54-year-old woman with chronic pelvic inflammatory disease and pyelonephritis developed persistent hyperamylasemia with transient increases in the amylase-creatinine clearance ratio. Even though chronic pancreatitis was suspected clinically, at postmortem examination the pancreas was found to be normal. We suggest that the hyperamylasemia resulted from entry into the circulation of amylase produced within sequestered endosalpingeal epithelial cysts, possibly amplified by impaired renal clearance. Thus, the potential of the serum amylase assay as a sign of serous ovarian tumors is further indicated.

Diagnosis of acute pancreatitis using the amylase-creatinine clearance ratio and radionuclide hepatobiliary and pancreas imaging.

AbstractAmylase‐creatinine clearance ratio and radionuclide hepatobiliary and pancreas imaging were used together as noninvasive screening procedures in 24 patients suspected of having acute pancreatitis. An increased amylase‐creatinine clearance ratio, normal filling of the gallbladder demonstrated by the radionuclide study, and decreased uptake of the radionuclide in the pancreas scan were helpful in reaching the diagnosis of acute pancreatitis.

The amylase-creatinine clearance ratio following cardiopulmonary bypass

The incidence of unexplained pancreatitis in patients dying after cardiac operations has been recorded as 16%, with evidence to implicate ischemia in the pathogenesis of the pancreatitis. Increased amylase--to--creatinine clearance ratios (ACCR), suggesting pancreatic dysfunction, have been reported in patients following nonpulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is increasingly recognized to be a more physiological form of perfusion, particularly with respect to capillary blood flow. In this study the ACCR has been determined before, during, and after cardiac operations performed with both nonpulsatile and pulsatile CPB. Twenty patients undergoing elective cardiac operations were studied. Ten patients had nonpulsatile CPB (nonpulsatile group) and 10 had pulsatile CPB (pulsatile group). The two groups were comparable as regards perioperative variables and perfusion parameters. In both groups the ACCR was estimated preoperatively, on three occasions during the operation, and daily on the first 5 postoperative days. A significant elevation in ACCR was observed in nine of 10 patients in the nonpulsatile group but in only one of 10 patients in the pulsatile group (p less than 0.001). The significant improvement of ACCR stability following pulsatile CPB may indicate that this form of perfusion will reduce the risk of pancreatitis following cardiac operations performed with CPB.

Clinical evaluation of amylase-creatinine clearance ratio and amylase isoenzyme clearance in chronic renal failure.

Amylase-creatinine clearance ratio (ACCR) and amylase isoenzyme clearance were determined simultaneously in patients with chronic renal failure. ACCR in patients with compensated renal failure (3.5 +/- 0.4%) was not significantly different from normals (2.6 +/- 0.2%), while that in patients with non-compensated renal failure (6.7 +/- 0.4%) was significantly higher than that in normals. Clearance ratio of pancreatic isoamylase (Amylase-1) relative to creatinine clearance (CAmy . 1/Ccr) in patients with both compensated (5.9 +/- 1.0%) and non-compensated (6.8 +/- 0.4%) renal failure was as high as that in patients with acute pancreatitis (6.6 +/- 0.5%). On the other hand, clearance ratio of salivary isoamylase (Amylase-3) relative to creatinine clearance (CAmy . 3/CCr) in patients with compensated renal failure (1.5 +/- 0.3%) was almost the same as that in normals (2.1 +/- 0.1%), while that in patients with non-compensated renal failure was 5.9 +/- 0.7%, which was significantly higher than that in normals. The present study revealed that elevated ACCR in patients with severely impaired renal function was due to the increase of the clearance ratio for both pancreatic and salivary amylase. These facts suggested that glomerular permeability and tubular reabsorption for pancreatic and salivary amylase might play an important role on ACCR in patients with severely impaired renal function.

Assessment of the amylase--creatinine clearance ratio in postoperative patients.

The value of the amylase--creatinine clearance ratio (ACCR) in the diagnosis of postoperative pancreatitis was prospectively assessed. In 77 patients undergoing operations known to have a significant incidence of postoperative pancreatitis (gastric, biliary or pancreatic) i.e. "high risk" group, the ACCR was abnormally elevated postoperatively in 36 patients (47%). However, overt clinical pancreatitis occurred in only eight patients (10%). In 60 other patients undergoing nonabdominal operations (orthiipedic, head and neck, varicose vein surgery etc.) i.e. "low risk" group, the ACCR was abnormally elevated postoperatively in 23 patients (38%). No patient in this group developed clinical pancreatitis. We conclude, therefore, the ACCR is often abnormally elevated nonspecifically following any type of surgery, and cannot be used as evidence of postoperative pancreatitis. These data do suggest, however, that a normal ACCR, especially on successive daily determinations, might help to exclude the diagnosis of postoperative pancreatitis.

The ultrasonic and biochemical diagnosis of pancreatitis in children

Pancreatic ultrasonography and the determination of serum amylase and amylase creatinine clearance ration were performed on 17 normal children and on 35 children with abdominal pain. In all 17 normal subjects the echodensity of the pancreas was equal to or greater than that of the liver. Nineteen patients with abdominal pain had reduced echodensity of the pancreas when compared to that in normal children, and two of the 19 had pseudocysts. Serum amylase values and/or amylase creatinine clearance ratio correlated poorly with ultrasonic and clinical evidence of pancreatitis.

Amylase-Creatinine Clearance Ratio

To the Editor. — During the past three years, after numerous articles related to the amylase-creatinine clearance ratio in the diagnosis of acute pancreatitis, we have investigated the usefulness of this test and found consistently that the clearance ratio is a relatively insensitive test for patients with acute pancreatitis. It should be emphasized that, by performing the ratio, there are actually four analytical determinations, ie, two amylase and two creatinine. On the basis of cost effectiveness, the ratio should, therefore, be compared with the four separate determinations of either serum or urine amylase. We found that the clearance ratio is no more effective than doing a single determination of both serum and urine amylase in the diagnosis of acute pancreatitis. I have one suggestion to put at rest the amylase-creatinine clearance ratio; the title of the article by Farrar and Calkins published in theArchives(138:958-962, 1978) should be entitled

Sensitivity of the Amylase-Creatinine Clearance Ratio in Acute Pancreatitis

An elevated amylase-creatinine clearance ratio has been established as being highly specific for the diagnosis of acute pancreatitis. In the present study, the sensitivity of this test was compared to that of the serum amylase and the one-hour urinary amylase test in 29 patients with acute pancreatitis. Abnormal elevations of the amylase-creatinine clearance ratio were found less frequently than abnormal elevations of the serum and one-hour urinary amylases. Moreover, abnormal elevations of the amylase-creatinine clearance ratio showed less deviation from normal and values returned to normal sooner than those of the serum and one-hour urinary amylases. When compared to the serum amylase and the one-hour urinary amylase tests, the amylase-creatinine clearance ratio is a relatively insensitive test in patients with acute pancreatitis.

Sensitivity of the amylase-creatinine clearance ratio in acute pancreatitis

Sensitivity of the amylase-creatinine clearance ratio in acute pancreatitis