title: Clinical course of acute pancreatitis in chronic kidney disease patients in a single kidney center (PGTi) in Karachi.
abstract: BACKGROUND
  The aim of this study was to assess the clinical course, etiology and complications of acute pancreatitis among chronic kidney disease (CKD) patients in a tertiary care renal center in Karachi.
  
  
  METHODS
  We retrospectively evaluated the clinical course of CKD patients who presented to our emergency room with signs and symptoms of acute pancreatitis over a period of two years.
  
  
  RESULTS
  During the study period, 247 CKD patients presented to our emergency room with symptoms suggestive of acute pancreatitis. Only 43 patients (17.4%) had more than a threefold increase in serum amylase and/or lipase levels fulfilling the diagnostic criteria of acute pancreatitis. They included 25 pre-dialysis CKD patients (58.13%) and 18 end stage renal failure patients (41.86%) on regular hemodialysis (HD). Among the 25 pre-dialysis CKD patients, 17 patients developed acute kidney injury (AKI), ten of whom required temporary HD. Twelve of those patients (70%) returned back to their baseline renal functions after 3-4 weeks. Gallstones were the cause of pancreatitis in seven patients (16.3%) while no cause was identified in 29 patients (67.4%). Nine patients (20.9%) developed multi-organ failure and 12 patients (27.9%) required admission to the intensive care unit (ICU). All patients survived except for one patient (2.3%) who died in the ICU. patients with less than threefold increase in serum amylase and lipase levels responded well to conservative management and had a favorable clinical course.
  
  
  CONCLUSIONS
  In severe acute pancreatitis the mortality rate can be as high as 40-58% especially in association with comorbid conditions. In this series of CKD patients however, the overall mortality rate was 2.3%, probably due to the predominance of milder forms of pancreatitis.
authors.affiliation: Kidney Center (PGTi), Karachi, Pakistan. neph.kiran@yahoo
authors.forename: Kiran
authors.initials: K
authors.lastname: Nasir
authors.forename: Aasim
authors.initials: A
authors.lastname: Ahamd
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010154:Pakistan; D010195:Pancreatitis / Q000097:blood / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D008049:Lipase; D000681:Amylases