THROMBOLYTIC TREATMENT AND PROTEINURIA

Objectives-To determine whether patients with acute myocardial infarct ion undergoing thrombolysis with streptokinase develop changes in rena l function. Design-Prospective assessment of renal function in 60 cons ecutive patients admitted with acute myocardial infarction. Setting-Te rtiary referral centre and city general hospital. Patients-60 consecut ive patients with acute myocardial infarction. Thirty eight were given streptokinase and 17 tissue plasminogen activator (alteplase) and fiv e no thrombolytic agent (non-streptokinase group). Main Outcome Measur es-Proteinuria and creatinine clearance on admission (day 1) and on da ys 3 and 6; serum urea and creatinine concentrations on days 1 and 7; streptokinase IgG on days 1, 2, and 7. Results-Significant proteinuria (> 0.15 g/24 h) was found in 31 (82%) of the 38 patients in the strep tokinase group (mean 0.47 g/24 h (95% confidence interval 0.35 to 0.6 g/24 h)) in the 24 hours after admission compared with six (27%) out o f 22 in the non-streptokinase group (mean 0.17 g/24 h (0.12 to 0.2 g/2 4 h); P = 0.008). In the streptokinase group this decreased to the nor mal range by day 3 (mean 0.15 g/24 h (0.1 to 0.22 g/24 h); P = 0.0001 v baseline). Electrophoresis of urine showed the proteinuria to be glo merular in origin. Creatinine clearance and serum creatinine and urea concentrations were similar in both groups. In the streptokinase group detectable streptokinase IgG titres were found in 28 out of 32 (87%) patients. The median titre on admission was 16 (range 0-110); it fell to 3 (range 0-80; P = 0.001) by day 2 and increased to 61 (range 0-770 0; P = 0.0002 v baseline) by day 7. Conclusions-Streptokinase was asso ciated with significant early onset proteinuria of glomerular origin. This started to resolve by day 3 and resulted in no deterioration in o verall renal function. The temporal relation to the initial fall in an tibody titre suggests that it could be the result of immune complex de position in the glomeruli.