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Metformin is a drug increasingly used in the treatment of diabetic patients. In addition to its hypoglycemic effect, it reduces vascular risk and does not determine an increase in body weight. Compared to the older molecule, phenformin, metformin possesses a lower risk of induction of severe lactic acidosis in the general diabetic population. On the other hand, metformin must be used with caution in patients with kidney damage. In patients with a glomerular filtration rate (GFR) below 30 ml/min, the use of metformin is also associated with a high risk of lactic acidosis. The assessment of glomerular filtration rate using MDRD or CKD-EPI formulas allows the clinician to identify patients potentially at risk. All subjects with normal renal function treated with metformin for years are at risk of suddenly developing lactic acidosis during episodes of acute worsening renal function. We report a case of lactic acidosis in association with acute kidney injury (AKI).

Plasmatic amylase increases quite often in uremia. Hyperparathyroidism is also present in uremic patients and it is thought to be the main factor of an increased of amylase; its effect is mediated by an increase of cytosolic calcium. The authors measured the plasmatic level of amylase, lipase, calcium phosphates and parathormone before and after administration of Ca-antagonists (Verapamil and Diltiazem). The results did not shown any correlation. Hyperparathyroidism increased the pancreatic secretion but don't influences the amount of enzymes.