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Bleeding in renal failure: a possible cause

M Kazatchkine, Y Sultan, J P Caen

    British Medical Journal
    |September 11, 1976
    PubMed
    Summary
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    Patients with chronic renal failure exhibit abnormal factor VII protein levels, leading to prolonged bleeding. Kidney transplantation resolves this, but rejection episodes can cause concerning increases in factor VII-von Willebrand activity.

    Area of Science:

    • Nephrology
    • Hematology
    • Vascular Biology

    Background:

    • Chronic renal failure (CRF) is associated with bleeding complications.
    • The role of coagulation factors in CRF-related hemostatic abnormalities requires further elucidation.

    Purpose of the Study:

    • To investigate the levels and function of factor VIII-related antigen (VIIIRA), factor VIII-procoagulant activity (VIIIC), and factor VII-von Willebrand activity (VIIIVWF) in patients with CRF.
    • To assess the impact of dialysis and kidney transplantation on these factor levels.

    Main Methods:

    • Plasma samples from patients with CRF, undergoing dialysis, post-kidney transplantation, and healthy controls were analyzed.
    • Levels of VIIIRA, VIIIC, and VIIIVWF were measured using specific assays.

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    Main Results:

    • Patients with CRF showed increased VIIIRA and VIIIC, but decreased VIIIVWF.
    • Dialysis did not improve the VIIIVWF abnormality.
    • Successful kidney transplantation normalized VIIIVWF levels by six months post-transplant.
    • Acute reversible rejection was associated with persistently low VIIIVWF.
    • Hyperacute irreversible rejection correlated with significantly elevated VIIIVWF, VIIIRA, and VIIIC, suggesting a thrombogenic risk.

    Conclusions:

    • Factor VII dysfunction contributes to bleeding in CRF.
    • Kidney transplantation can restore normal factor VII function.
    • Factor VII abnormalities, particularly elevated VIIIVWF during rejection, may indicate thrombotic risk in transplant recipients.