Changes Of Plasma Fibrinogen,D-dimer,Fibrin Degradation Products And Association With Kidney Injury In Children With Henoch-Sch(?)nlein Purpura Nephritis

Changes of plasma fibrinogen, D-dimer,fibrin degradation products and association with kidney injury in children with Henoch-Sch(o|¨)nlein purpura nephritisObjective It was not clear that the cause and the mechanisms of kidney injury in Henoch-Sch(o|¨)nlein purpura (HSP) in Children. The study had suggested that the blood coagulation and fibrinolysis participated the process of pathophysiology of HSP. To investigate the changes of blood coagulation and fibrinolysis in acute stage of HSP in children and the association between that and kidney injury, 127 children with HSP in acute stage, admitted in our hospital, were enrolled in the study. The levels of plasma fibrinogen(FIB), D-dimer(D-D), fibrin degradation products(FDP) and 24-hour urinary protein excretion and serum creatinine were investigated, and the correlation between them were analyzed.Methods①127 children with HSP, admitted in our hospital from Jan 2009 to June 2010, the diagnosis of HSP was made according to the European League against Rheumatism (EULAR) criteria in 2005. None of patients had received glucocorticoids and immunosuppressants in one month before hospitalization.②127 HSP children were classified into two groups according to the kidney injury:, 52 children with kidney injury (HSPN) into HSPN group, 75 HSP children with no kidney injury into HSP group, and 25 healthy children as normal control group.③Blood samples were obtained from peripheral vein in the morning after overnight fasting in all the 152 children, before glucocorticoids treatment. Plasma FIB,D-D,FDP,PT,APTT, 24h-urinary protein excretion, serum creatinine were observed, and the correlation between them were analyzed.④The data analyses were made with SPSS 12.0.Results①The plasma FIB(g/L), D-D(mg/L), FDP(mg/L) level respectively were: HSPN group 2.90±0.81, 1.15±0.71, 1.52±0.93, HSP group 2.91±0.77, 0.90±0.58, 1.29±0.95, and normal control group 1.95±0.49, 0.34±0.12, 0.94±0.38. The plasma FIB, D-D and FDP levels in the HSPN group were significantly higher than that in normal control group(P<0.01). The plasma FIB and D-D level in the HSP group were significantly higher than that in normal control group(P<0.01). Plasma D-D in the HSPN group was significantly higher than that in the HSP group (P<0.01), but the difference of plasma FIB, FDP level between the HSPN group and the HSP group were no statistical significance (P>0.05).②24-hour urinary protein excretion quantity (g/24h) were 1.50±1.15 in HSPN group, 0.10±0.05 in HSP group, and 0.07±0.02 in normal control group.③There were significantly positive correlation between the level of plasma D-D, FDP respectively and 24-hour urinary protein excretion quantity (r=0.475,P<0.01;r=0.529,P<0.01). There was positive correlation between FIB and 24-hour urinary protein excretion quantity but no statistical significance ( r=0.193, P>0.05).Conclusion The plasma FIB, D-D and FDP levels in acute stage of Henoch-Sch(o|¨)nlein purpura nephritis in Children were significantly higher than normal children. The study suggested that there were the abnormality of blood coagulation and fibrinolysis in acute stage of Henoch-Sch(o|¨)nlein purpura nephritis. The secondary fibrinolysis are probably involved in the process of kidney injury in Henoch-Sch(o|¨)nlein purpura nephritis.