Altered urinary fractional clearance of trypsin (Clirt/CLcr) in chronic pancreatic disease

In about one third of th patients with chronic pancreatitis or with pancreatic cancer an increase in ClIRT/Clcr has been repeatedly described, but the mechanism underlying this finding is at present unknown. This study was aimed at investigating whether different molecular weight tiypsins or a renal defect can explain the increased ClIRT/Clcr values in these diseases. The serum of 12 controls, of 20 patients with chronic pancreatitis and of 18 with proven pan¬creatic cancer was submitted to gel chromatography (Sephacryl S 200). LAD-isoenzymes, gamma GT and alphaglycosidase were measured in 12-hour urine. In these subjects ClIRT/Clcr was calc-ulated and an increase was found in 40% of the patients with pan¬creatic disease. No difference in the molecular weight distribution of serum IRT was found among the three groups and no relationship was found between the CliRT/Clcr and the profile of the mo¬lecular weight of serum IRT. Moreover, an increase in urinary enzymes, suggestive of a renal dysfunction, was found in subjects both with high and normal ClIRT/Clcr. In conclusion, present data suggest that the molecular weight distribution of trypsin does not affect the ClIRT/Clcr, but the available tests gave no conclusive evidence for a renal involvement in the altered ClIRT/Clcr values.