Does renal tubular dysfunction account for the enhanced C_Am C_Cr ratio in acute pancreatitis?

To verify whether renal tubular dysfunction may account for the C_Am C_Cr enhancement in acute pancreatitis (AP), we have measured the renal excretion of amylase, lysozyme, and gamma-glutamyl-transpeptidase (GGTP) in 22 patients with AP and in 8 with acute tubular necrosis. While the C_Am C_Cr ratio was elevated in most patients with AP, the C_Lys C_Cr ratio fell within the normal range in 60% of these patients. The subdivision of patients with AP in subgroups with elevated and normal C_Lys C_Cr ratios revealed a mean C_Am C_Cr not statistically different. Moreover, no correlation was present in AP between amylase vs. both lysozyme and GGTP clearances. These data suggest that tubular dysfunction does occur in some but not in all the patients with AP and seems not to play a major role in the pathogenesis of the increased C_Am C_Cr ratio in this condition.