Acute Pancreatitis and Renal Failure.

ACUTE oliguric renal failure complicating acute pancreatitis is rare and many standard texts fail to mention it. Russell Taylor (1949) found it only once in 110 such patients, and in 163 examined post mortem Blumenthal and Probstein (1959) found only one case where a lower nephron nephrosis seemed to be related to postoperative haemorrhage and shock, although albuminuria without evidence of further renal damage is not infrequent in acute pancreatitis (Siler and Wulsin, 1951). However, Balslov, Jorgensen and Nielsen described thirteen examples of renal failure in 1962 and reviewed 27 others from the world literature. The aetiology is not well understood, but causes such as shock (Beisel, Herndon, Myers and Stones, 1959), dehydration (Ducrot and Slama, 1960), anoxia (Beisel and others, 1959), bouts of fever (Edlund, 1950), fat emboli in glomerular capillary tufts (Lynch, 1954) and thrombi in renal vessels (Ducrot and Slama, 1960) have been suggested. Ducrot and Slama (1960) found acute pancreatitis as the cause of renal failure in seven of 400 patients with acute renal failure and Balslov and others (1962) found thirteen in their series of 300. Among 30 patients with acute pancreatitis admitted to the hospital over the past ten years none had acute renal failure. Four recent examples are described here who developed renal failure in the absence of any of the known causative factors mentioned above, and which was not recognized in two instances until late in the course of the patients' illness. The nature of the renal lesion is discussed.