Decrease in renal function following decreased fibrinogen and raised fibrin degradation products in lupus nephritis with nephrotic syndrome.

Abstract

To clarify the relationship between renal function and laboratory indicators of abnormal blood coagulation in lupus nephritis with nephrotic syndrome, we studied 28 patients with this disease over the 11 years. Follow-up tests included serial determination of plasma fibrinogen, serum fibrin degradation products (FDP), serum creatinine and endogenous creatinine clearance (Ccr) as well as other parameters. Either decreased fibrinogen, elevated FDP, or both were found in 13 cases. Taking as a criterion of decreased renal function an increase in serum creatinine above 0.2 mg/100 ml combined with a decrease in Ccr by more than 30% below the immediately preceding values, 11 of the above 13 patients showed a marked deterioration in renal function concurrently or within two weeks after the episodes of clotting disorder. Two other patients showed a less marked decrease in renal function. The 15 patients whose circulating fibrinogen and FDP remained normal did not show deterioration in renal function. The difference in renal function decrease between the groups with and without abnormal hemocoagulation indicators is significant. Our preliminary results indicate that when fibrinogen and FDP indicate intravascular hypercoagulation deterioration in renal function in patients with lupus nephritis is probable.