We sought to determine whether the clinical setting in which
pancreatitis occurs affects the incidence and distribution of increased values of renal clearance of
amylase relative to
creatinine, CAm/CCr, and whether the increased values reflect a tubular disorder that impairs renal reclamation of certain low molecular weight
proteins. We measured the renal clearance of three low molecular weight
proteins (
amylase,
beta 2-microglobulin, and
lysozyme) and urinary excretion of three lysosomal
enzymes that originate from the renal tubule in three groups of patients (
alcoholic pancreatitis,
pancreatitis without
alcoholism, and
alcoholism without
pancreatitis). When compared to normal controls, the mean CAm/CCr was significantly elevated in
alcoholic pancreatitis (p less than 0.05) but not in equally severe
pancreatitis without
alcoholism nor in
alcoholism without
pancreatitis. The clearance ratio of
beta 2-microglobulin was significantly increased in each of the three patient groups; mean clearance ratio of
lysozyme was not significantly increased in any of the patient groups. Excretion of each of the three lysosomal
enzymes was significantly increased in each of the patient groups. We conclude that the etiology of
pancreatitis affects the distribution of values for CAm/CCr, impaired tubular reclamation of
amylase is the mechanism of the increase in CAm/CCr, and
a factor or factors associated with both
pancreatitis and with
alcoholism per se appear to disorder the renal tubule and to impair tubular reclamation of some but not all low molecular weight
proteins-a novel finding of considerable potential significance.