[Serine proteinase activity in children with hemolytic-uremic syndrome]

Haemolytic-uremic syndrome (HUS) is the leading cause of acute renal failure in the childhood. It is characterised by microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure and injury of the renal microvascular endothelium. In HUS the condition of proteolytic kallikrein-kinin system is unknown. The renal KKS seems to participate in the regulation of blood pressure, control of sodium and water excretion, renal vascular resistance and renin release. In this study the role kallikrein in the developing HUS was studied. The general activity of kallikrein in plasma and urine was determined by trypsin-like peptidohydrolase activity (TP), which was measured using substrate Z-D-Ala-Leu-Arg-pNa. Chymotrypsin-like protease activity (ChP) was measured using substrate Glp-Ala-Ala-Leu-pNa. Clinical data were analysed on 60 pediatric patients with HUS, 29 girls and 31 boys, ranging in the age from 3 months to 11 years. TP and ChP levels were determined in different periods of HUS (anuria, diuresis beginning, polyuria, recovery) in serum and urine. In acute phase TP and ChP activities increased significantly. In diuresis recovery serum TP activity was higher, but urine TP level became normal. In dynamic serum and urine ChP levels had tendency to decrease. The present work showed that TP and ChP levels demonstrated activity of pathological renal process and condition of glomerules.