Urinary FDP D-Dimer and E Fragments in Renal Transplantation

Abstract

Both D-dimer and E fragments in urinary FDP were determined in renal transplantation patients. Urinary D-dimer fragments increased in 14 out of 20 acute rejections (70.0%) and in 6 out of 18 chronic rejections (33.3%). Urinary E fragments increased in 8 out of 9 acute rejections (88.9%) and in 4 out of 5 chronic rejections (80.0%). It is suggested that urinary FDP-E fragment is a better indicator to detect or predict rejection than the whole Urinary FDP. The appearance of D-dimer in the urine indicates intravascular coagulation in glomeruli followed by a secondary fibrinolysis in the course of the rejection reaction. The urinary D-dimer/FDP ratio which was used as the indicator of fibrinolytic activity in glomeruli was obtained in various conditions of renal transplants. The ratios were relatively high in the urines from well functioning grafts. This ratio deteriorated at the onset of rejection crisis and tended to go upward during the course of the recovery when the rejection was reversible. In the cases of irreversible acute rejection and chronic rejection, these ratios remained at a low level. D-dimer/FDP ratio might be useful indicator to predict the reversibility of rejection and the prognosis of renal allograft. Furthermore, these findings suggest that fibrinolytic and thrombolytic therapy by the tissue-type plasminogen activator (t-PA) along with immunosuppressive drugs might be more effective for the treatment of these rejections.

Studies on Changes in Parameters of the Coagulation and Fibrinolysis in Association with Extracorporeal Shock Wave Lithotripsy

“…PIC is a complex of cb-plasmin inhibitor and plasmin. cb-Plasmin inhibitor, which has the capacity to adjust the fibrinolytic system of the body, can instantly and irreversibly link to plasmin to form an important sub stance to maintain and adjust the dissolving of a throm bus [10], PIC reflects plasmin production through the inactivation of plasminogen, and can be used as an impor tant index of acceleration of various fibrinolytic functions [11], D-D is a fraction of the degradation product formed only through the secondary fibrinogenolysis of stabilized fibrin, and FDP is a degradation product of fibrin and fibrinogen [12], In ESWL for renal stones, elevation of the blood level of TAT occurred on the 1st postoperative day and eleva tion of the blood level of PIC occurred on the 3rd postop erative day. Studies on blood levels of TAT and PIC after partial hepatectomy revealed that the elevation of TAT reached a peak between immediately and 1 day after the operation, PIC, on the other hand, between 3 and 5 days after the operation [13].…”