Case report of oxalate nephropathy in a patient with pancreatic metastases from renal carcinoma

Abstract Background Patients with metastatic renal carcinoma frequently have pre-existing renal impairment and not infrequently develop worsening renal function as a complication of their treatment. The presence of pancreatic metastases in patients with metastatic renal carcinoma, often confers a more favourable prognosis and as a consequence this patient group may be exposed to such treatments for more prolonged periods of time. However, the development of renal failure may also be a consequence of the cancer itself rather than its treatment. Case presentation We present an 84-year-old patient receiving the tyrosine kinase inhibitor (TKI) pazopanib for metastatic renal carcinoma who developed oxalate nephropathy as a consequence of pancreatic exocrine insufficiency resulting from pancreatic metastases. Conclusions This case demonstrates the importance of investigating unexpected toxicities and highlights the potential consequences of pancreatic insufficiency and its sequelae in patients with pancreatic metastases.

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Should we Investigate Gastroenterology Patients for Pancreatic Exocrine Insufficiency? A Dual Centre UK Study

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.253.uks ◽

2016 ◽

Vol 25 (3) ◽

pp. 303-309 ◽

Cited By ~ 11

Author(s):

Jennifer A. Campbell ◽

David S. Sanders ◽

Katherine A. Francis ◽

Matthew Kurien ◽

Sai Lee ◽

...

Keyword(s):

Secondary Care ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Enzyme Replacement ◽

Co Morbidity ◽

Immunodeficiency Virus ◽

Pancreatic Enzyme Replacement Therapy ◽

Pancreatic Exocrine

Background & Aims: Pancreatic exocrine insufficiency may be under recognised in gastroenterological practice. We aimed to identify the prevalence of pancreatic insufficiency in secondary care gastroenterology clinics and determine if co-morbidity or presenting symptoms could predict diagnosis. A secondary aim was to assess response to treatment. Methods: A dual centre retrospective analysis was conducted in secondary care gastroenterology clinics. Patients tested for pancreatic exocrine insufficiency with faecal elastase-1 (FEL-1) between 2009 and 2013 were identified in two centres. Demographics, indication and co-morbidities were recorded in addition to dose and response to pancreatic enzyme replacement therapy. Binary logistic regression was used to assess if symptoms or co-morbidities could predict pancreatic insufficiency. Results: 1821 patients were tested, 13.1% had low FEL-1 (<200μg/g). This prevalence was sub-analysed with 5.4% having FEL-1 100-200μg/g (mild insufficiency) and 7.6% having faecal elastase readings <100μg/g. Low FEL-1 was most significantly associated with weight loss or steatorrhoea. Co-morbidity analysis showed that low levels were significantly associated with excess alcohol intake, diabetes mellitus or human immunodeficiency virus; 80.0% treated with enzyme supplements reported symptomatic benefit with no difference in response between high and low dose supplementation (p=0.761). Conclusion: Targeting the use of FEL-1 in individuals with specific symptoms and associated conditions can lead to improved recognition of pancreatic exocrine insufficiency in a significant proportion of secondary care patients. Intervening with lifestyle advice such as smoking cessation and minimising alcohol intake could improve outcomes. In addition, up to 80% of patients with low faecal elastase respond to supplementation. Abbreviations: CFA: coefficient of fat absorption; CP: chronic pancreatitis; ELISA: enzyme-linked immune-absorbent assay; PEI: pancreatic exocrine insufficiency; FEL-1: faecal elastase-1; HIV: human immunodeficiency virus; IBD: inflammatory bowel disease; IBS: irritable bowel syndrome; PERT: pancreatic enzyme replacement therapy.

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Anasarca, steatorrhea, and hypoalbuminemia 18 years after total gastrectomy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0721-7 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Yu Igata ◽

So Okubo ◽

Yu Ohkura ◽

Masaki Ueno ◽

Harushi Udagawa

Keyword(s):

Total Gastrectomy ◽

Fluid Management ◽

Capillary Leak ◽

Pancreatic Exocrine Insufficiency ◽

Multidisciplinary Team Meeting ◽

Exocrine Insufficiency ◽

Case Presentation ◽

Albumin Infusion ◽

History Of ◽

Pancreatic Exocrine

Abstract Background Pancreatic exocrine insufficiency (PEI) is known to occur after total gastrectomy. We experienced a case of PEI occurring 18 years after surgery, leading to a potentially fatal condition of capillary leak syndrome (CLS). Case presentation The case is a 58-year-old man on a healthy diet who underwent total gastrectomy 18 years before. He was admitted for a 3-month history of anasarca, steatorrhea, and hypoalbuminemia. An episode of fever occurred during workup, followed by pulmonary edema and shock. The patient was transferred to the intensive care unit and was started on fluid management with albumin infusion. A multidisciplinary team meeting was held, and a clinical diagnosis of PEI resulted in CLS was made and we started administration of oral pancrelipase to show clinical improvement. The patient was discharged, and he remained asymptomatic for 13 months. Conclusion In a post-gastrectomy patient with malnutrition, PEI should be suspected regardless of the period since surgery. When recognized, immediate replenishment of albumin and pancreatic enzymes should be initiated to prevent clinical deterioration.

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Treatment of Pancreatic Exocrine Insufficiency with Enteric Coated Pancreatin Formulations: An Overview

International Journal of Pharmaceutical Sciences and Nanotechnology ◽

10.37285/ijpsn.2013.6.3.3 ◽

2013 ◽

Vol 6 (3) ◽

pp. 2125-2130

Author(s):

B K Bhattacharyya ◽

S Chowdhury ◽

S Das ◽

S Mukherjee ◽

D Bhattacharjee

Keyword(s):

Cystic Fibrosis ◽

Digestive Enzymes ◽

Pancreatic Insufficiency ◽

Pancreatic Enzyme ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Enzyme Replacement ◽

Increased Risk ◽

Pancreatic Exocrine ◽

Enteric Coated

Pancreatin is a mixture of several digestive enzymes produced by the exocrine cells of the pancreas. It is composed of amylase, lipase and protease. It is used to treat conditions in which pancreatic secretions are deficient, such as surgical pancreatectomy, pancreatitis and cystic fibrosis. Pancreatin products contain the pancreatic enzymes trypsin, amylase and lipase. The patients with pancreatic diseases often suffer from pancreatic exocrine insufficiency. In such condition pancreas does not secrete required amount of digestive enzymes for proper digestion to occur. Severe pancreatic insufficiency occurs in cystic fibrosis, chronic pancreatitis, tumors or after surgical resection. Thus pancreatic exocrine insufficiency may result in clinical manifestation of malnutrition, weight loss and steatorrhea leading towards the increased risk of morbidity and mortality. For the improvement of clinical symptoms, restriction of fat intake and pancreatic enzyme replacement therapy are recommended. The enzyme substitution therapy is very much challenging because the optimal enzyme dose is highly variable to mimic the physiological pattern of pancreatic exocrine secretion. Regulatory authorities have approved several pancreatic enzyme formulations in the form of enteric coated minimicrosphere which are now available commercially. This review focuses on the physiological considerations of pancreatic exocrine insufficiency and its treatment with enteric coated pancreatin formulations.

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WS17.5 Is there need for a multienzyme product substitution when using high calorie liquid diets in patients with exocrine pancreatic insufficiency? Studies on praecaecal digestibility in pigs with experimentally induced pancreatic exocrine insufficiency

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(16)30161-8 ◽

2016 ◽

Vol 15 ◽

pp. S29 ◽

Cited By ~ 1

Author(s):

A. Mößeler ◽

B. Ahlfänger ◽

J. Kamphues

Keyword(s):

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Pancreatic Exocrine Insufficiency ◽

Product Substitution ◽

Exocrine Insufficiency ◽

Pancreatic Exocrine ◽

High Calorie ◽

Experimentally Induced

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COMPARISON OF FECAL ELASTASE 1 FOR EXOCRINE PANCREATIC INSUFFICIENCY EVALUATION BETWEEN EX-ALCOHOLICS AND CHRONIC PANCREATITIS PATIENTS

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000400006 ◽

2014 ◽

Vol 51 (4) ◽

pp. 297-301 ◽

Cited By ~ 5

Author(s):

Rejane MATTAR ◽

Gustavo André Silva LIMA ◽

Marianges Zadrozny Gouvêa da COSTA ◽

Joyce M Kinoshita SILVA-ETTO ◽

Dulce GUARITA ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Predictive Value ◽

Pancreatic Insufficiency ◽

Exocrine Pancreatic Insufficiency ◽

Pancreatic Exocrine Insufficiency ◽

Exocrine Insufficiency ◽

Noninvasive Test ◽

Fecal Elastase ◽

Elastase 1 ◽

Pancreatic Exocrine

Context Fecal elastase is a noninvasive test for pancreatic insufficiency diagnosis. Objectives Evaluate the usefulness of fecal elastase 1 for the indication of exocrine pancreatic insufficiency among former alcohol addicts and patients with chronic pancreatitis. Methods Forty-three patients with chronic pancreatitis and thirty-three asymptomatic former alcohol addicts entered the study. The levels of fecal elastase 1 were measured using a commercial kit. Pancreatic imaging findings were used to categorize the groups. Results The levels of fecal elastase 1 were significantly lower in the patients than in the former alcohol addicts and in the group with tissue calcifications, duct alterations, or atrophy. With a cutoff level of 100 μg/g, the sensitivity of fecal elastase 1 in chronic pancreatitis was 46.51% and its specificity was 87.88% with a positive predictive value of 83.33% and a negative predictive value of 55.77%. When patients were stratified according to the severity of their pancreatitis, the sensitivity was 6.25% for mild pancreatitis and 70.37% for marked pancreatitis. Conclusion Low level of fecal elastase 1 was associated with marked rather than mild chronic pancreatitis; however, it may be useful to indicate pancreatic exocrine insufficiency in asymptomatic former alcohol addicts.

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