cholecystokinin and Kidney-Failure--Chronic

There is evidence that under various physiological circumstances long-term adaptation of structure and function of the gut occurs. The mechanisms of these changes are not clear but gastro-intestinal hormones may be involved. In particular, gastrin which has been shown experimentally to stimulate growth and development of parts of the gut, probably has a role in maintaining the structure of the normal upper alimentary tract. Cholecystokinin may be of major importance in producing adaptive changes in the pancreas in response to dietary modifications and enteroglucagon is possibly concerned with maintaining a normal small intestinal structure. The importance of the 'trophic' action of gatrointestinal hormones is becoming more widely recognised and as new gastro-intestinal hormones become established, this aspect of their physiological importance as well as their acute effects, will deserve attention.

Topics: Animals; Cholecystokinin; DNA; Duodenum; Female; Gastric Mucosa; Gastrins; Gastrointestinal Hormones; Humans; Intestinal Diseases; Intestine, Small; Kidney Failure, Chronic; Lactation; Pancreas; Pregnancy; Rats; Secretin; Starvation; Weaning; Zollinger-Ellison Syndrome

We have used serial visual analogue scores to demonstrate disturbances of the appetite profile in dialysis patients. This is potentially important as dialysis patients are prone to malnutrition yet have a lower nutrient intake than controls. Appetite disturbance may be influenced by accumulation of appetite inhibitors such as leptin and cholecystokinin (CCK) in dialysis patients.. Fasting blood samples were drawn from 43 controls, 50 haemodialysis (HD) and 39 peritoneal dialysis (PD) patients to measure leptin and CCK. Hunger and fullness scores were derived from profiles compiled using hourly visual analogue scores. Nutrient intake was derived from 3 day dietary records.. Fasting CCK was elevated for PD (6.73 +/- 4.42 ng/l vs control 4.99 +/- 2.23 ng/l, P < 0.05; vs HD 4.43 +/- 2.15 ng/l, P < 0.01). Fasting CCK correlated with the variability of the hunger (r = 0.426, P = 0.01) and fullness (r = 0.52, P = 0.002) scores for PD. There was a notable relationship with the increase in fullness after lunch for PD (r = 0.455, P = 0.006). When well nourished PD patients were compared with their malnourished counterparts, CCK was higher in the malnourished group (P = 0.004). Leptin levels were higher for the dialysis patients than controls (HD and PD, P < 0.001) with pronounced hyperleptinaemia evident in some PD patients. Control leptin levels demonstrated correlation with fullness scores (e.g. peak fullness, r = 0.45, P = 0.007) but the dialysis patients did not. PD nutrient intake (energy and protein intake, r = -0.56, P < 0.0001) demonstrated significant negative correlation with leptin.. Increased CCK levels appear to influence fullness and hunger perception in PD patients and thus may contribute to malnutrition. Leptin does not appear to affect perceived appetite in dialysis patients but it may influence nutrient intake in PD patients via central feeding centres.

Topics: Adult; Aged; Appetite; Appetite Regulation; Cholecystokinin; Dialysis; Diet Records; Eating; Feeding Behavior; Female; Humans; Hunger; Kidney Failure, Chronic; Leptin; Male; Middle Aged; Nutritional Status; Satiation

Patients with chronic renal failure have an abnormal immunoreactive gastrointestinal hormone profile, which is characterised by raised fasting serum concentrations of hormones that have antagonistic effects on exocrine pancreatic function. In addition, in this present study we have found that in renal insufficiency cholecystokinin disappears slowly from the plasma after a constant intravenous infusion of the hormone (p = 0.05 compared with healthy subjects). To evaluate whether the stimulatory or inhibitory hormones have a predominant effect, pancreatic exocrine function under conditions of mannitol perfusion of the duodenum and continuous intravenous cholecystokinin stimulation was studied in eight patients who had severe chronic renal failure and eight age-matched and sex-matched control subjects. Compared with healthy subjects, patients with renal insufficiency had hypersecretion of trypsin in response both to mannitol perfusion of the duodenum and to cholecystokinin stimulation (p less than 0.05). No significant differences in lipase secretion were noted between the patients with renal insufficiency and control subjects. These findings are consistent with the hypothesis that, of the abnormally raised fasting serum concentrations of gastrointestinal hormones found in renal insufficiency, hormones that stimulate rather than inhibit pancreatic exocrine function predominate. Secondly, the dissociation between trypsin and lipase outputs in chronic renal failure may suggest a differential trophic influence of stimulatory hormones -- that is, hypercholecystokininaemia -- on pancreatic exocrine enzyme secretion.

Topics: Adult; Cholecystokinin; Gastrointestinal Hormones; Humans; Kidney Failure, Chronic; Lipase; Male; Mannitol; Middle Aged; Pancreas; Trypsin

The kidney has previously been shown to be a major site for the plasma clearance of pancreatic trypsinogens in the rat. This study investigated plasma concentrations of anionic and cationic trypsinogen in chronic renal failure and anephric patients. Plasma concentrations were significantly elevated in both groups of patients. Hemodialysis did not change their plasma levels. The plasma levels of anionic and cationic trypsinogens were highly correlated in patients and normal subjects; however, the relative concentrations of anionic trypsinogen were significantly higher in renal failure patients. This suggests that in patients with renal failure the secondary clearance mechanisms for these plasma proteins more efficiently clear cationic molecules. In normal dogs, intravenous infusion of synthetic octapeptide of cholecystokinin (CCK-8) resulted in small transitory increases in plasma trypsinogen levels. After nephrectomy, basal levels of anionic and cationic trypsinogen were elevated, and intravenous infusion of CCK-8 resulted in prolonged, high levels of plasma trypsinogens.

Topics: Animals; Cholecystokinin; Cross Reactions; Dogs; Glomerular Filtration Rate; Humans; Kidney; Kidney Failure, Chronic; Nephrectomy; Radioimmunoassay; Renal Dialysis; Trypsinogen

In 20 patients suffering from chronic renal failure treated by hemodialysis (CRFH) the pure pancreatic juice (PPJ) collected via endoscopic cannulation of the papilla was studied. PPJ was collected during 20 minutes in 1 minute samples. Secretin and pancreozymin (CCK-PZ) were given as boluses respectively at the beginning and at the 10th minute of the test. Volumes, total protein and bicarbonate concentrations, total protein and bicarbonate outputs, Lactoferrin (LF) levels were measured. The results observed in patients were compared to those of ten subjects free of any organic disease. The volume of PPJ was significantly more important in CRFH than in controls. Bicarbonate and protein concentrations were not significantly modified. Protein output was not significantly more important in CRFH at the exception of the 12th sample. Bicarbonate output was not significantly increased at the exception of the 9th and the 11th samples. LF level was more than 0.03% of total proteins in 4 CRFH.

Topics: Adult; Bicarbonates; Cholecystokinin; Female; Humans; Kidney Failure, Chronic; Lactoferrin; Male; Middle Aged; Pancreas; Pancreatic Juice; Proteins; Renal Dialysis; Secretin

Fasting serum gastrin, cholecystokinin, glucagon, and gastric inhibitory polypeptide concentrations were simultaneously measured in normal subjects and in patients with different degrees of renal failure. Values of gastrin, cholecystokinin, gastric inhibitory polypeptide, and glucagon were significantly higher in all patients with serum creatinine concentrations greater than 3 mg/dl than in controls (P less than 0.01). The degree of renal insufficiency was significantly correlated (P less than 0.05) with serum concentrations of each hormone, but no significant linear correlation existed among the serum concentrations of different gastrointestinal hormones in individuals. Hemodialysis did not significantly alter predialysis serum gastrin, cholecystokinin, or glucagon concentration, but the serum gastric inhibitory polypeptide concentration decreased by 30% (P less than 0.01) after hemodialysis. The disproportionate increases of hormones with antagonistic actions may alter gastrointestinal function in renal insufficiency.

Topics: Adult; Aged; Cholecystokinin; Creatinine; Female; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Humans; Kidney; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis

Topics: Acute Kidney Injury; Cholecystokinin; Gastric Inhibitory Polypeptide; Gastrins; Gastrointestinal Hormones; Glucagon; Humans; Kidney Failure, Chronic; Secretin

After a review of the literature the author's results of testing pancreatic function in 445 patients with different diseases are reported. The activities of serum amylase and lipase were estimated before and after stimulation with secretin and pancreozymin; at the same time exocrine secretions of the pancreas were collected in the duodenum and analyzed. Serum enzyme activity did not change markedly after stimulation in pronounced pancreatic insufficiency. Measuring the enzyme activity thus helped to make the diagnosis only in a few cases with chronic pancreatitis and pancreatic carcinoma. In all other patients there was no correlation between changes of serum enzyme activities and changes of exocrine pancreatic function. Pathological test results, that means an increase in enzyme activity after stimulation, were found not only in patients with established or suspected pancreatic diseases, but also in many other subjects. Thus the diagnostic relevance of these tests seems to be rather limited, since it does not prove or exclude with sufficient specificity or adequate probability the presence of pancreatic diseases; it therefore cannot be recommended for screening purposes.

Topics: Amylases; Cholecystokinin; Chronic Disease; Diabetes Mellitus; Enzymes; Gastrointestinal Diseases; Humans; Kidney Failure, Chronic; Lipase; Liver Diseases; Pancreatic Neoplasms; Pancreatitis; Secretin

Pancreatic function tests were performed in 15 patients with advanced renal insufficiency. Pancreatic secretion was stimulated with CCK/PZ and secretin and 60 minutes later with bile given intraduodenally and CCK/PZ and secretin intravenously. The Wilcoxon-test showed that there were significantly higher lipase levels in serum and lower amylase amounts in duodenal juice compared to normal volunteers. No differences could be demonstratd for volume, maximal bicarbonate concentration, lipase and trypsin outputs. It could be shown by nonlinear discriminant analysis that pancreatic secretion might specifically be changed in patients with chronic renal failure. These patients can be definitely differentiated according to the secretion pattern from normal controls and patients with chronic pancreatitis, pancreatic carcinoma, chronic and acute duodenal ulcer.

Topics: Adult; Aged; Alkaline Phosphatase; Amylases; Bicarbonates; Bile; Blood Proteins; Calcium; Cholecystokinin; Creatinine; Duodenum; Female; Humans; Intestinal Secretions; Kidney Failure, Chronic; Lipase; Male; Middle Aged; Pancreas; Potassium; Secretin; Trypsin

Topics: Acute Kidney Injury; Amylases; Biliary Tract Diseases; Cholecystokinin; Gastrointestinal Diseases; Hepatitis; Humans; Kidney Failure, Chronic; Lipase; Methods; Pancreas; Pancreatic Neoplasms; Pancreatitis; Parotitis; Secretin

Topics: Acute Kidney Injury; Amylases; Cholecystokinin; Clinical Enzyme Tests; Diagnostic Errors; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Lipase; Ovarian Cysts; Pancreatic Neoplasms; Pancreatitis; Photometry; Pregnancy; Pregnancy, Ectopic; Salivary Gland Diseases; Secretin

Topics: Amylases; Bicarbonates; Cholecystokinin; Chronic Disease; Humans; Injections, Intravenous; Kidney Diseases; Kidney Failure, Chronic; Lipase; Methods; Pancreas; Pancreatic Diseases; Pancreatic Juice; Secretin