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Coagulation and fibrinolysis in patients with chronic renal failure undergoing conservative treatment
S Tomura1, Y Nakamura, F Deguchi
1Department of Internal Medicine, Nakano General Hospital, Tokyo, Japan.
Insights
Chronic renal failure patients show increased coagulation activity, indicated by higher thrombin-antithrombin III complex (TAT) levels. Fibrinolysis is only slightly enhanced, suggesting TAT, alpha 2-plasmin inhibitor-plasmin complex (alpha 2 PIC), and cross-linked fibrin degradation products (XL-FDP) are reliable markers.
Area of Science:
- Nephrology
- Hematology
- Clinical Chemistry
Background:
- Chronic renal failure (CRF) can impact hemostasis.
- Understanding coagulation and fibrinolysis in CRF is crucial for patient management.
Purpose of the Study:
- To evaluate enhanced coagulation and fibrinolytic activity in CRF patients undergoing conservative treatment.
- To assess the utility of specific markers for coagulation and fibrinolysis in renal impairment.
Main Methods:
- Measured plasma levels of thrombin-antithrombin III complex (TAT), alpha 2-plasmin inhibitor (alpha 2 PI)-plasmin complex (alpha 2 PIC), and cross-linked fibrin degradation products (XL-FDP) in 18 CRF patients and normal controls.
- Correlated these markers with serum creatinine, albumin, and total protein levels.
Main Results:
- CRF patients had significantly higher fibrinogen and TAT levels compared to controls.
- Antithrombin III (ATIII) activity was significantly lower in CRF patients.
- Alpha 2 PIC and XL-FDP levels were slightly elevated in CRF patients.
- No correlation was found between TAT, alpha 2 PIC, XL-FDP, and serum creatinine levels.
Conclusions:
- Coagulation activity is significantly increased in CRF patients.
- Fibrinolysis secondary to coagulation is only slightly enhanced.
- TAT, alpha 2 PIC, and XL-FDP are reliable indicators of coagulation-fibrinolysis, even in patients with reduced renal function.
Abstract:
Eighteen patients with chronic renal failure due to primary glomerular disease undergoing conservative treatment (CRF patients) were studied to evaluate whether coagulation and fibrinolytic activity in plasma are enhanced in the patients. We measured plasma levels of coagulation-fibrinolysis parameters including thrombin-antithrombin III complex (TAT) (an index of thrombin formation), alpha 2-plasmin inhibitor (alpha 2 PI)-plasmin complex (alpha 2 PIC) (an indicator of plasmin production) and cross-linked fibrin degradation products (XL-FDP) (an index of fibrinolysis secondary to coagulation). There was no correlation between plasma levels of TAT, alpha 2PIC and XL-FDP and serum creatinine levels in CRF patients. Both fibrinogen and TAT were found to be significantly higher in CRF patients than in normal controls. TAT was negatively correlated with serum albumin or total protein. Antithrombin III (ATIII) activity was significantly lower in CRF patients than in normal controls. CRF patients showed significantly but slightly higher alpha 2 PIC and XL-FDP when compared to normal controls. These results suggest that TAT, alpha 2PIC and XL-FDP are good indicators of coagulation-fibrinolysis even in patients with decreased renal function. Coagulation activity is significantly increased in CRF patients but fibrinolysis secondary to coagulation is only slightly enhanced.