Post written by Thiruvengadam Muniraj, MD, from the Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.

Post-ERCP pancreatitis (PEP) is the most common adverse event after ERCP. Despite adoption of several strategies such as rectal indomethacin, pancreatic duct stent placement, and aggressive fluid administration, incidence of PEP remains substantial. Identifying patients who are likely to develop PEP before discharge would be of great clinical benefit, especially in those who would benefit from overnight observation after ERCP.

Preclinical studies have shown that renalase, a plasma flavoprotein produced predominantly in the kidney with anti-inflammatory effects, is significantly reduced in the setting of acute pancreatitis and, thus, may be a useful PEP biomarker.

We enrolled 273 participants without prior ERCP, excluding patients with chronic kidney failure. Blood samples were drawn from patients before ERCP and 30 and 60 minutes after ERCP to measure their plasma renalase levels. The PEP rate was 11.4%.

We analyzed the baseline levels and trajectory of renalase levels to determine if they were associated with development of PEP. In total, 39 patients had a renalase level >6.0 µg/mL at baseline, but only 1 patient developed PEP (2.6%). 

In contrast, among the remaining 234 patients with low baseline renalase levels (≤6.0 µg/mL), the PEP rate was 12.8%. Our findings indicated that patients with low baseline renalase levels are at significantly greater risk for PEP, suggesting that the baseline native renalase levels are very sensitive for predicting PEP.

If these findings are confirmed in larger studies, renalase could be a useful pre-ERCP biomarker to identify patients with the highest risk for developing PEP and could have a potential role as a novel therapeutic agent for preventing PEP.

Plasma native renalase levels over time for patients without (NOPEP) and with (PEP) post-ERCP pancreatitis. The red line indicates the regression line. X-axis, time; y-axis, native (free) renalase levels in ng/mL.

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