Uremic pancreatitis following routine initiation of losartan in advanced chronic kidney disease: A case report

Angiotensin receptor blockers (ARBs) are commonly used to slow the progression of chronic kidney disease (CKD) but may worsen renal function in advanced kidney disease. We describe a 35-year-old man with stage 4 CKD who developed acute kidney injury shortly after starting an ARB, followed by severe abdominal pain and biochemical evidence of pancreatitis. Imaging excluded gallstones and ductal obstruction. Laboratory studies ruled out hypertriglyceridemia and hypercalcemia. He was found to have profound azotemia, consistent with uremia. His abdominal pain and elevated pancreatic enzymes improved rapidly with hemodialysis, supporting a diagnosis of uremic pancreatitis rather than direct losartan toxicity. Uremic pancreatitis is rare and usually described in patients with end-stage renal disease; its occurrence in earlier CKD stages is underrecognized. This case highlights uremia as a rare cause of pancreatitis that should be considered in the setting of worsening azotemia and abdominal pain. Patients should be carefully monitored when initiating ARBs in the setting of advanced CKD.