Changes of coagulation and fibrinolytic factors observed during heparin-urokinase-pulse combined therapy for nephritis resistant to conventional treatment in children

Coagulation and fibrinolytic factors in the blood were measured during heparinurokinase (UK)-pulse combined therapy in order to investigate the background for the availability of the therapy. Five patients with nephritis resistant to conventional treatment were treated with this combined therapy (heparin:350-450 U/kg day, continuously i.v.during the therapy;UK:5000 IU/kg/2hrs, i.v., two times a day, for 3 days=l Kur; methyl-prednisolone 20mg/kg/2hrs, d.i.v., for 3 days=l Kur; 3 Kurs of UK and 3 Kurs of pulse were alternately administered).1) Blood levels of α2-plasmin inhibitor (α2PT) antigen were decreased and those of α2-plasmin inhibitor· plasmin complex (α2-PI. PmC) were elevated during 3 Kurs of UK administration.Accordingly, activation of the fibrinolytic system was confirmed during the combined therapy, suggesting that both α2-PI and α2-PI·PmC were relevant in monitoring the fibrinolytic state in blood.2) Both tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAT-1) levels were sustained continuosly in the elevated levels in the blood during both UK administration and pulse therapy. This movement of t-PA and PAI-1 was independent of that of the other fibrinolytic factors, such as α2-PI, α2-PI·PmC and plasminogen.3) Inflammatory reactants such as fibrinogen, α2-PI, α2macroglobulin and α1-antitrypsin decreased more significantly during this heparinurokinase-pulse combined therapy than during our previous combined therapy consisting of only heparin and urokinase. Therefore, we conclude that the anti-inflammatory effect was reinforced by adding the pulse therapy and that the combined therapy had some effect on the release of t-PA from vascular endotherial cells