EVALUATION OF SERUM LIPASE LEVEL IN NON DIABETIC CHRONIC KIDNEY DISEASE PATIENTS.

Background: Chronic kidney disease is a progressive loss in renal function over period of many months or years. There is decline in nephron function and number generally quantitated as reduction in glomerular filtration rate. As the GFR declines there is accumulation of metabolic end products excreted by kidney. Serum lipase is mainly marker of pancreatic & hepatobiliary disease but its level is also high in chronic renal disorder. Lipase is filtered by glomerulus and almost completely reabsorbed and metabolised by renal tubules, thus chronic kidney disease patient have elevated serum lipase level. Our study was aimed to find out the status of serum lipase in non diabetic chronic kidney disease subjects and healthy controls. Materials and Methods: The present study is a case control study, conducted on 100 non diabetic chronic

CKD is a type of kidney disease in which there is gradual loss of kidney function over a period of months or years [2,3]. CKD represents a progressive, irreversible decline in glomerular filtration rate (GFR) [4]. All kidney diseases progress to terminal renal failure relatively independent of the initial disease. Diabetic nephropathy, chronic glomerular diseases and hypertensive nephrosclerosis are among the most widespread causes of CKD [5]. Most chronic nephropathies unfortunately lack a specific treatment and progress relentlessly to end-stage renal disease (ESRD). Progressive renal function loss is a common phenomenon in renal failure, irrespective of the under-lying cause of the kidney disease [6]. Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, and polycystic kidney disease [3,7]. Other health conditions that may lead to CKD are obesity, high cholesterol, a family history of the disease, lupus, and other forms of cardiovascular diseases.
The primary disease eventually leads to secondary glomerular injury and nephron loss that is clinically characterized by proteinuria and hypertension, which leads to inflammation or scarring which causes kidney failure and ultimately a gradual elevation in the plasma creatinine concentration and a progressive decline in GFR [8]. The excessive protein filtration, caused by the glomerular hypertension, might per se have toxic effects on the kidneys and increase the rate of progression [9]. Serum lipase is mainly marker of pancreatic & hepatobiliary diseases but its level is also high in chronic renal disorder. Lipase is an enzyme that catalyses the breakdown of triglycerides [10]. In addition to pancreatic acinar cells, lipase is found in the gastrointestinal tract, including the oesophagus, duodenum, stomach and colon [10]. Lipase has also been described in the liver, heart, lungs and leukocytes [10,11]. The serum amylase and lipase are frequently elevated in patients with CRF in the absence of clinical pancreatitis [12]. Lipase is filtered by glomerulus and almost completely reabsorbed and metabolised by renal tubules. The serum pancreatic enzymes are often elevated within three-folds normal in ESRD patients. Thus, acute pancreatitis must be considered if enzyme levels are more than three-folds normal in association with clinical manifestations [13]. Blood urea and serum creatinine are widely accepted and most commonest parameters to assess renal functions. In India 8-10% of adult population have some form of renal disorder. If CKD is detected early and managed appropriately the detoriation in kidney functions can be slowed and risk of cardiovascular diseases in renal patients can be reduced. Our study was aimed to find out the status of serum lipase level in non diabetic chronic kidney disease patient and healthy controls.

Materials And Methods:-
The present study is a case control study, conducted on 100 non diabetic chronic kidney disease patients . Patients were diagnosed as chronic kidney disease on the basis of clinical history, physical examination & serum urea and serum creatinine level. Cases were selected from Urology and Medical ward of Jawahar Lal Nehru Medical College and Associated Group of Hospitals, Ajmer. Age and sex matched healthy controls (n = 50) were selected from MOPD of Jawahar Lal Nehru Medical College and Associated Group of Hospitals, Ajmer. The results of patients were compared with healthy controls (n=50 ). The present study is approved by Institutional Ethical Committee.

For control group
Healthy individuals age and sex matched without renal disease. Blood samples were collected after an overnight fast (12-14hrs) under aseptic conditions from all the study participants. All samples were centrifuged and analysed for blood sugar, serum urea and serum creatinine and serum 539 lipase. The blood sugar was measured by enzymatic GOD-POD end point method. Serum urea was measured by enzymatic end point colorimetric method. Serum creatinine was measured by Jaffe's colorimetric kinetic method. Serum lipase was measured by colorimetric kinetic assay. The normal serum lipase level is 12-70 U/L.

Statistical analysis:-
All data were analysed by SPSS-13 version. P< 0.01 were considered as significant.

Results:-
A total of 150 subjects were studied. The results are summarized in Tables and Figures. The Table-1, Figure-1 show the Mean±SD of blood sugar , serum urea , serum creatinine and serum lipase. The Table-1, Figure-

Discussion:-
Chronic kidney disease (CKD) is a worldwide health problem, affecting millions of people [1]. Causes of chronic kidney disease include diabetes, high blood pressure, glomerulo-nephritis and polycystic kidney disease [3,7]. Other health conditions that may lead to CKD are obesity, high cholesterol, a family history of the disease kidney disease, lupus and other forms of cardiovascular diseases.
In the present study we have observed the level of serum lipase was elevated in non diabetic chronic kidney disease patients as compared to the healthy subjects (controls) . It is in concordance with the previous studies which also state that the serum lipase was elevated in chronic kidney disease patients [12,13,14].
Our finding are in agreement with Jiange et al. (2002) found that the mean activity of serum lipase was significantly higher in chronic kidney disease patients campared to the Healthy subjects (controls) (p<0.0001) and reported that the serum pancreatic enzymes are often elevated within three-folds normal in ESRD patients. Thus, acute pancreatitis must be considered if serum lipase levels are more than three-fold normal in association with clinical manifestations [13].
Serum lipase is mainly marker of pancreatic & hepatobiliary disease but its level is also high in chronic renal disorder. Twenty percent of pancreatic enzymes are excreted by the kidney. Thus patients with end stage renal disease have elevated levels of serum pancreatic enzymes. Serum lipase levels are increased in patients with renal insufficiency due to decreased excretion of the enzyme. The levels are not as high as pancreatitis, lipase is filtered by glomerulus and almost completely reabsorbed and metabolised by renal tubules. Reduced clearance of lipase from the circulation can occur with chronic renal failure [15,16,17]. The observations of this study also revealed that 85 out of 100 non diabetic chronic kidney disease patients have higher serum lipase levels than normal (>70 541 U/L). Serum lipase can be used as a biomarker for the early detection of chronic kidney disease in the general population to prevent the morbidity and mortality which are associated with chronic kidney disease.

Conclusion:-
Serum lipase was found to be elevated in non diabetic chronic kidney disease patients. Serum lipase as a diagnostic tool in recognizing acute pancreatitis leads to false positive results in chronic kidney disease patients. The observations of this study has also revealed that 85 out of 100 non diabetic chronic kidney disease patients have higher serum lipase levels than normal (>70 U/L). Serum lipase can be used as a biomarker for the early detection of chronic kidney disease in the general population to prevent the morbidity and mortality which are associated with chronic kidney disease.