The Plasma Renin-Angiotensin System in Human Acute Pancreatitis

Pezzilli R, Barakat B, Fantini L, Timpano A, Morselli Labate AM, Corinaldesi R

Department of Internal Medicine and Gastroenterology and Department of Emergency, Sant’Orsola-Malpighi Hospital, University of Bologna. Bologna, Italy

ABSTRACT

Context Activation of the local pancreatic renin-angiotensin system (RAS) has been reported in experimental acute pancreatitis. At present, no data are available in humans. Aim To evaluate the plasma RAS in human acute pancreatitis. Patients Twenty-one patients with acute pancreatitis (13 males, 8 females, mean age 57.9 years, range 20-84 years) were studied within 24 hours of pain onset. None of the patients enrolled had arterial hypertension or other known diseases nor were they taking drugs capable of modifying the RAS. The pancreatitis was of biliary origin in 16 patients, due to alcohol abuse in three, due to pancreatic biopsy in one, and of unknown origin in the remaining one. According to the Atlanta criteria, 14 patients (66.7%) had mild acute pancreatitis and seven (33.3%) the severe form of the disease. Methods In all patients, plasma renin activity (reference range 0.2-2.8 ng/mL/h), plasma angiotensin I converting enzyme activity (reference range 65.8-114.4 U/L) and plasma aldosteron concentration (reference range 33-489 pg/mL) were determined immediately after hospital admission using commercial available kits. Serum amylase and lipase activities were also determined. Statistical analysis was carried out using the Mann-Whitney and the Spearman rank correlation tests. Results Mean±SD plasma renin activity, angiotensin I converting enzyme activity, and aldosteron concentration were 0.73±0.84 ng/mL/h, 56.8±30.4 U/L, and 92.2±112.8 pg/mL, respectively. In particular, the plasma renin activity was above the reference range in one patient (4.8%); the plasma angiotensin I converting enzyme activity was above the reference range in one patient (4.8%) and below the reference range in 15 patients (71.4%); plasma aldosteron concentration was below the reference range in five patients (23.8%). No significant relationship was found between serum amylase or lipase activities and plasma renin activity, plasma angiotensin I converting enzyme activity or aldosteron concentration. Furthermore, no significant relationship was found between plasma renin activity, angiotensin I converting enzyme activity and aldosteron concentration and the severity of the disease. Conclusions The RAS may be impaired in patients with acute pancreatitis and it does not seem to be related to the severity of the disease.

Congress Proceedings in PDF format