HEMOSTASIS ACTIVATION MARKERS IN ACUTE-RENAL-FAILURE

Fibrinopeptide A and thrombin-antithrombin III complex were used respe ctively as markers for in vivo thrombin formation and beta-thromboglob ulin as a marker for platelet activation. In cases of acute renal fail ure (ARF) a heightened plasma concentration in the hemostasis activati on markers may occur, because of a renal elimination disturbance witho ut a previous activation of the hemostasis. In order to check the vali dity of fibrinopeptide A, thrombin-antithrombin III complex and beta-t hromboglobulin as markers for the hemostasis activation in cases of AR F we examined 32 patients prior to renal replacement therapy. A signif icant rise in fibrinopeptide A (x +/- SD: 34 +/- 22 ng/mL, ref < 3.0), thrombin-antithrombin III complex (19 +/- 15 ng/mL, ref 1.0-4.0) and beta-thromboglobulin (149 +/- 58 U/mL, ref 10-40) was found. None of t he parameters examined showed a correlation to the serum creatinine. A correlation was observed respectively between fibrinopeptide A (r = 0 .34, p < .05), beta-thromboglobulin (r = 0.39, p < .05) and the beta-t hromboglobulin/creatinine coefficient (0.50 +/- 0.30, r = 0.72, p < .0 01 on the one side and the thrombin-antithrombin III complex on the ot her. A greater rise in the concentration of all parameters in patients with disseminated intravascular coagulation (DIG) was established in contrast to patients without DIC (fibrinopeptide A: 44 +/- 31 vs. 32 /- 20 ng/mL, beta-thromboglobulin: 169 +/- 57 vs. 144 +/- 60 U/mL, thr ombin-antithrombin III complex 40 +/- 21 vs. 14 +/- 7 ng/mL, p < .05). Fibrinopeptide A and beta-thromboglobulin/creatinine coefficient in c ombination with the thrombin-antithrombin III complex can be employed as markers for the activation of hemostasis in cases of ARF There is n o direct relationship between restricted kidney function in ARF and th e plasma concentration of these markers, which behave similarly in spi te of their varying elimination patterns.