Elevation of plasma thrombomodulin level in primary glomerulonephritis with heavy proteinuria

Thrombomodulin (TM) is a thrombin receptor found on endothelial cells. TM acts as a cofactor for the thrombin-catabolized activation of protein C and protects these cells from the formation of thrombi. We hypothesized that the soluble form of TM which reflects the damage of the endothelial cells and that simultaneously, soluble TM will be affected by renal excretion because a significant positive correlation has been found between soluble TM and serum creatinine (sCr) in the renal failure state. However, there have been no reports on the relationship between plasma TM and clinical parameters except for sCr in primary glomerulonephritis (PGN). Plasma TM (pTM) and urinary TM (uTM) were measured in 107 patients with PGN using a one-step sandwich enzyme immunoassay. These values were assessed together with other laboratory and histological findings. We were able to divide all subjects into two groups: an sCr-dependent group whose sCr level was over 1.2 mg/dl and an sCr-independent group whose sCr level was under 1.2 mg/dl. In the sCr-independent group, patients who suffered from nephrotic syndrome (NS) had a much higher pTM level than patients who did not suffer from NS. Histological findings and other parameters were not correlated with pTM or uTM. Therefore, the two patients who suffered from NS with very high pTM levels and normal sCr level at the time of admission exhibited a decrease in their pTM value as their condition improved. We concluded that in our patients, pTM was affected not only by renal excretion of TM, but also by renal damage with heavy proteinuria and may have been associated with an ongoing disease process in PGN.