Mechanism of Increased Renal Clearance of Amylase/Creatinine in Acute Pancreatitis

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Abstract
We investigated three possible causes of the increased ratio of amylase/creatinine clearance observed in acute pancreatitis. The presence of rapidly cleared isoamylase was excluded by studies of serum and urine, which demonstrated no anomalous isoamylases. In pancreatitis, the ratios (±1 S.E.M.) of both pancreatic isoamylase (9.2±0.6 per cent) and salivary isoamylase (8.6±1.6 per cent) were significantly (P2-microglobulin, which is relatively freely filtered at the glomerulus and then avidly reabsorbed by the normal tubule. During acute pancreatitis the ratio of the renal clearance of β2-microglobulin to that of creatinine was 1.22±0.52 per cent, an 80-fold increase over normal (0.015±0.002 per cent), with a rapid return toward normal during convalescence. Presumably, this reversible renal tubular defect also reduces amylase reabsorption and accounts for the elevated renal clearance of amylase/creatinine observed in acute pancreatitis. (N Engl J Med 295:1214–1217, 1976)

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