Serum enzymes in patients with renal failure
- Neil S Sanghani, MD
Neil S Sanghani, MD
- Assistant Professor of Medicine
- Vanderbilt University Medical Center
- Ramesh Soundararajan, MD, FACP
Ramesh Soundararajan, MD, FACP
- Clinical Assistant Professor of Internal Medicine
- Midwestern University College of Medicine
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
The serum enzymes of patients with end-stage renal disease (ESRD) are commonly abnormal. This is due in part to the absence of renal excretion and to the frequent presence of multiple comorbid conditions. Since the diagnosis of many diseases is based upon the detection of elevated levels of these enzymes, the accurate clinical assessment of the patient with ESRD is hampered by a paucity of knowledge concerning the serum concentrations of different enzymes in various disease states.
The use and significance of variations in the concentrations of serum enzymes in dialysis patients will be reviewed here. A discussion of serum cardiac enzymes in patients with renal failure is presented separately. (See "Serum cardiac biomarkers in patients with renal failure".)
The serum enzymes most commonly used to help assess the diagnosis of hepatobiliary disease include the aminotransferases, alkaline phosphatase, and gammaglutamyl transpeptidase (GGT).
Aminotransferases — Serum concentrations of aspartate and alanine aminotransferase (AST [SGOT] and ALT [SGPT]) are routinely measured to assess liver function in patients with and without renal failure. The aminotransferases are normally present in the circulation in low concentrations, usually <40 int. units/L. (See "Approach to the patient with abnormal liver biochemical and function tests", section on 'Liver enzymes'.)
The concentrations of serum aminotransferases in both chronic dialysis and chronic renal failure patients most commonly fall within the lower end of the range of normal values [1-4]. Although the exact cause is unknown, possible underlying reasons may be related to pyridoxine deficiency (pyridoxal phosphate is a necessary coenzyme for ALT and AST) [5-7] and/or the presence of an inhibitory substance in the uremic milieu .
- Cohen GA, Goffinet JA, Donabedian RK, Conn HO. Observations on decreased serum glutamic oxalacetic transaminase (SGOT) activity in azotemic patients. Ann Intern Med 1976; 84:275.
- Nanji AA. Decreased activity of commonly measured serum enzymes: causes and clinical significance. Am J Med Technol 1983; 49:241.
- Guh JY, Lai YH, Yang CY, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995; 69:459.
- Fabrizi F, Lunghi G, Finazzi S, et al. Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. Am J Kidney Dis 2001; 38:1009.
- Wolf PL, Williams D, Coplon N, Coulson AS. Low aspartate transaminase activity in serum of patients undergoing chronic hemodialysis. Clin Chem 1972; 18:567.
- Hamfelt A. The effect of pyridoxal phosphate on the aminotransferase assay in blood. Scand J Clin Lab Invest Suppl 1966; 18:Suppl 92:181.
- Rej R, Fasce CF Jr, Vanderlinde RE. Increased aspartate aminotransferase activity of serum after in vitro supplementation with pyridoxal phosphate. Clin Chem 1973; 19:92.
- Fabrizi F, Lunghi G, Andrulli S, et al. Influence of hepatitis C virus (HCV) viraemia upon serum aminotransferase activity in chronic dialysis patients. Nephrol Dial Transplant 1997; 12:1394.
- Hung KY, Lee KC, Yen CJ, et al. Revised cutoff values of serum aminotransferase in detecting viral hepatitis among CAPD patients: experience from Taiwan, an endemic area for hepatitis B. Nephrol Dial Transplant 1997; 12:180.
- Espinosa M, Martin-Malo A, Alvarez de Lara MA, et al. High ALT levels predict viremia in anti-HCV-positive HD patients if a modified normal range of ALT is applied. Clin Nephrol 2000; 54:151.
- Fine A, McIntosh WB. Elevation of serum gamma-glutamyl transpeptidase in end-stage chronic renal failure. Scott Med J 1975; 20:113.
- Royse VL, Jensen DM, Corwin HL. Pancreatic enzymes in chronic renal failure. Arch Intern Med 1987; 147:537.
- Bastani B, Mifflin TE, Lovell MA, et al. Serum amylases in chronic and end-stage renal failure: effects of mode of therapy, race, diabetes and peritonitis. Am J Nephrol 1987; 7:292.
- Vaziri ND, Chang D, Malekpour A, Radaht S. Pancreatic enzymes in patients with end-stage renal disease maintained on hemodialysis. Am J Gastroenterol 1988; 83:410.
- Lin XZ, Chen TW, Wang SS, et al. Pancreatic enzymes in uremic patients with or without dialysis. Clin Biochem 1988; 21:189.
- Caruana RJ, Altman R, Fowler B, et al. Correlates of amylase and lipase levels in chronic dialysis patients. Int J Artif Organs 1988; 11:454.
- Kimmel PL, Tenner S, Habwe VQ, et al. Trypsinogen and other pancreatic enzymes in patients with renal disease: a comparison of high-efficiency hemodialysis and continuous ambulatory peritoneal dialysis. Pancreas 1995; 10:325.
- Shibasaki T, Matsuda H, Ohno I, et al. Significance of serum lipase in patients undergoing hemodialysis. Am J Nephrol 1996; 16:309.
- Masoero G, Bruno M, Gallo L, et al. Increased serum pancreatic enzymes in uremia: relation with treatment modality and pancreatic involvement. Pancreas 1996; 13:350.
- Collen MJ, Ansher AF, Chapman AB, et al. Serum amylase in patients with renal insufficiency and renal failure. Am J Gastroenterol 1990; 85:1377.
- Jiang CF, Ng KW, Tan SW, et al. Serum level of amylase and lipase in various stages of chronic renal insufficiency. Zhonghua Yi Xue Za Zhi (Taipei) 2002; 65:49.
- Robitaille R, Lafrance JP, Leblanc M. Altered laboratory findings associated with end-stage renal disease. Semin Dial 2006; 19:373.
- Schoenicke G, Grabensee B, Plum J. Dialysis with icodextrin interferes with measurement of serum alpha-amylase activity. Nephrol Dial Transplant 2002; 17:1988.
- Anderstam B, García-López E, Heimbürger O, Lindholm B. Determination of alpha-amylase activity in serum and dialysate from patients using icodextrin-based peritoneal dialysis fluid. Perit Dial Int 2003; 23:146.
- Montalto G, Soresi M, Carroccio A, et al. Influence of haemodialysis on lipase activity. Eur J Clin Chem Clin Biochem 1997; 35:237.