BLOOD FIBRINOLYSIS AND THE RESPONSE TO DESMOPRESSIN IN GLOMERULONEPHRITIS

Fibrinolytic parameters and von Willebrand factor (VWF) antigen were m easured in 22 patients with glomerulonephritis (GN) who underwent rena l biopsy after desmopressin (DDAVP) infusion. Blood was collected imme diately before and after DDAVP infusion, after one week, and 3-6 month s later. The main abnormalities on admission were the following: the m ean baseline levels of t-PA antigen and VWF were significantly higher in GN patients than in 22 healthy controls; the median t-PA activity a nd the mean scu-PA level were significantly lower than normal. The t-P A response to DDAVP was impaired in 7 patients (32%), the response of VWF in 9 patients (41%), and the u-PA: Ag response in 11 patients (50% ). When the patients were stratified according to creatinine clearance rate, significant differences between the subgroups with severely and moderately impaired renal function were noted: the baseline levels of PAI activity and VWF were higher in patients with severe renal failur e and the VWF response to DDAVP was significantly lower. The response of u-PA (not of t-PA or VWF) to DDAVP appeared to correlate with urine flow during the first 24 h, suggesting the dependence of u-PA release on intact nephrons. A series of 18 patients with adult-type polycysti c kidney disease (APKD) with creatinine clearance rates in the same ab normal range as the GN patients, had lower mean PAI and a significantl y higher mean scu-PA level. Normalization of scu-PA and t-PA: Ag level s during follow-up despite impaired renal function in GN, and the abse nce of depressed scu-PA levels in APKD suggest that the fibrinolytic a bnormalities are independent of the impaired renal function per se, bu t associated with the acute stage of nephritis.