Abstract
Various factors affecting coagulation and fibrinolysis, such as factor VIII procoagulant activity, factor VIII related antigen, von Willebrand factor activity, fibrinogen, plasminogen-plasmin, plasmin inhibitor and fibrin degradation product (F. D. P.) in blood were studied together with plasminogen activator, plasminogen-plasmin and F. D. P. in urine for a total of 45 cases of Schönlein-Henoch purpura which include 25 male and 20 female Japanese children of 2 to 15 years of age.
These children were classified into 4 groups, according to clinical manifestations: Group 1, which included 20 patients with no renal complications; Group 2, which included 16 patients with acute glomerulonephritis; Group 3, which included 9 patients with nephrotic syndrome; Group 4, which included no patient in this study and in whom chronic nephritis was evident.
Group 1 showed a high level of serum F. D. P. in 13 cases, at the initial stage, but the other fibrinolytic factors, factor VIII procoagulant activity, factor VIII related antigen and von Willebrand factor activity fell within normal range. The high level of serum F. D. P. returned to almost normal after 2 to 4 weeks.
Group 2 showed, at the initial stage, high levels (over 150%) of factor VIII procoagulant activity, factor VIII related antigen and von Willebrand factor activity in 5-8 cases and normal ranges were reverted to 3 weeks to 3 months later. A moderate increase was observed in fibrinogen content in 8 cases and a high level of serum F. D. P. in 15. Urinary levels of plasminogen activator, plasminogen-plasmin and F. D. P. were increased in 10-20 cases. Normal ranges were reverted to 6 weeks to 3 months later.
Group 3 showed, at the initial stage, high levels of factor VIII procoagulant activity, factor VIII related antigen and von Willebrand factor activity, in 6-7 cases and all levels returned to normal except for a few cases. An increase was observed in plasma fibrinogen, plasminogen-plasmin and serum F. D. P. in most cases. Levels of plasminogen activator, plasminogen-plasmin and F. D. P. in the urine were increased significantly in all cases.
Renal biopsy was performed on 17 children with Schönlein-Henoch purpura accompained with renal symptoms and histological findings and deposition of fibrin or factor VIII related antigen in the glomerular lesion were investigated.
Histological observations revealed with minimal change, 7 with proliferative glomerulonephritis, 2 with focal segmental glomerulonephritis and 5 with focal lobular glomerulonephritis.
The degree of glomerular fibrin deposits correlated closely with plasma fibrinogen, plasminogen-plasmin in plasma and urine, and F. D. P. in serum and urine.
The degree of glomerular deposition of factor VIII related antigen showed a close correlation not only with factor VIII procoagulant activity, factor VIII related antigen and von Willebrand factor activity, but with fibrin deposition.
