Role of intrarenal coagulation and anticoagulant therapy in the progression of diabetic nephropathy.

The aim of the present study was to clarify the role of intrarenal coagulation in the progression of renal dysfunction and to assess the efficacy of anticoagulant therapy in diabetic nephropathy patients. Forty-one diabetic patients were divided into 2 groups: group 1 (G-1), 20 patients with nephropathy; and group 2 (G-2), 21 patients without nephropathy. The levels of fibrinopeptide A (FPA) and fibrinopeptide B beta 15-42 (FPB beta 15-42), fibrin/fibrinogen degradation products-D dimer (FDP-D dimer), and FDP-E products (FDP-E) and FDP, which are sensitive parameters of coagulation and fibrinolysis, were measured by radioimmunoassay, enzyme immunoassay (EIA), and latex photometric immunoassay, respectively, in both the blood and urine. The levels of urinary FPA, FDP-D, FDP-E, and FDP were found to be much higher in G-1 than in G-2. Significant relations were observed among the urinary levels of these four parameters. The renal function in all cases with higher levels of urinary parameters was severely deteriorated. Following heparin administration to these patients, marked reductions of the urinary FPA, FDP-D, and FDP-E and improvement of nephrotic syndrome were observed. The present data suggest that in diabetic nephropathy: (1) intrarenal coagulation is likely to occur and to induce progression of renal dysfunction; and (2) heparin therapy could be effective in diabetic nephropathy when the patients are selected according to the above parameters of coagulation and fibrinolysis.