各種腎疾患における糸球体内血液凝固の検討

抄録

Fibrin-Fibrinogen degradation products (FDP) have been found in the blood and urine of many patients with renal disease. This FDP has been regarded as evidence of intraglo-merular coagulation in renal disease. As there are two types of FDP which result from fibrinogenolysis and fibrinolysis, it may be useful to detect the D-dimer which results from fibrinolysis in order to diagnose intraglomerular coagulation. To clarify the role of intraglomerular coagulation in renal disease, blood and urinary FDP D-dimer were examined in comparison with renal histology and fibrinolytic activity in 122 patients with various renal diseases. The defibrinated plasma and urine were subjected to immunoabsorbance affinity chromatography, and then to SDS-polyacrylamide gel electrophoresis. Finally by analysis of densitometry, the fragments X, Y, D, E and D-dimer were detected The D-dimer of renal vein blood in 19 patients was also investigated o The results were as follows: 1) D-dimer in peripheral vein blood was found in 21 of 96 cases (21.9 %) and in urine in 23 of 57 cases (40.4%). 2) In moderate or severe proliferative glomerulonephritis, membranoproliferative glome- rulonephritis, chronic renal failure and systemic lupus erythematosus, higher incidence of blood and urinary D-dimer was shown than in other types. 3) There was no particular relationship between D-dieter of peripheral vein blood and fibrinolytic factors. 4) There was no obvious relationship between peripheral vein blood D-dimer and urinary D-dimer. 5) In urine, the ratio of D-dimer to D fraction (RD-D) was higher than in blood, and there was higher incidence of severe histological findings in cases of high urine and blood RD-D levels. 6) Blood and urinary D-dimer positive cases examined by immunofluorescence had more massive intraglomerular fibrin deposits than D-dimer negative cases. 7) There was no, obvious relationship between the changing levels of FDP, D-dimer and RD_D in arterial blood, renal vein blood and peripheral vein blood.