SPLIT PRODUCTS OF FIBRIN IN HUMAN RENAL DISEASE

A semiquantitative immunologic precipitin tube assay for split products of fibrin (SPF) was employed to reveal subtle degrees of intravascular coagulation not detected by measurement of coagulation factors. This test was used in the evaluation of 124 cases of pediatric renal disease to determine which of these disorders may be associated with intravascular coagulation. The majority of patients with acute nephritis (seven of nine), chronic nephritis (sixteen of twenty-one), lupus nephritis (four of four), the hemolytic-uremic syndrome (five of five) and uremia (eight of eight) had SPF in their serum during the course of their illness. These patients often have microscopic or immunofluorescent evidence of fibrin deposition within the kidney, depressed serum complement and abnormal immune processes. In contrast, most patients with the nephrotic syndrome, anaphylactoid purpura, urinary tract infection, hereditary nephritis and obstructive uropathy had no SPF in their serum. Simultaneous assays of SPF, haptoglobin and β1c globulin were found to be useful diagnostic aids in some forms of renal disease. Serial assays of SPF in conjunction with renal biopsies in several patients suggest that their presence indicates active glomerular inflammation; accordingly their determination is of value in following the course of these disorders and as a guide for steroid, immunosuppressive or anticoagulant therapy. Heparin was used in two patients with positive SPF tests, with possible benefit in one patient with acute nephritis and no benefit in a second patient with chronic nephritis and uremia. The choice of patients for heparin therapy must be highly selective to provide evidence for therapeutic benefit. On the basis of these studies three groups of kidney disorders can be delineated: those without intravascular coagulation (nephrosis, anaphylactoid purpura, urinary tract infection); those with generalized intravascular coagulation (hemolytic-uremic syndrome, uremia); and those with localized intravascular coagulation, possibly associated with abnormal immune processes (acute nephritis, chronic nephritis, lupus erythematosus with nephritis). © 1969.