Islet autotransplantation in a patient with hypercoagulable disorder

Total pancreatectomy and islet auto transplantation is a good option for chronic pancreatitis patients who suffer from significant pain, poor quality of life, and the potential of type 3C diabetes and pancreatic cancer. Portal vein thrombosis is the most feared complication of the surgery and chances are increased if the patient has a hypercoagulable disorder. We present a challenging case of islet auto transplantation from our institution. A 29-year-old woman with plasminogen activator inhibitor-4G/4G variant and a clinical history of venous thrombosis was successfully managed with a precise peri- and postoperative anticoagulation protocol. In this paper we discuss the anti-coagulation protocol for safely and successfully caring out islet transplantation and associated risks and benefits.

Effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia

Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.

Mortality and Thromboembolic Events in Hypercoagulable States from Rotational Thromboelastography (ROTEM) in Patients Who Undergo Coronary Bypass Surgery

Purpose: This study is to identify the prevalence of preoperative hypercoagulability in Thailand high-risk population assessed by Rotational thromboelastography (ROTEM) and test hypothesis that the pre-surgical ROTEM statuses are related to MACCE at 1, 12, 60 months after coronary bypass graft surgery (CABG). Method: This is a prospective cohort in consecutive patients who underwent on-pump CABG between 2013-2015. Blood samplings were collected and analyzed using ROTEM preoperatively. Hypercoagulable state was defined as any clotting time (CT) or clot formation time (CFT) below the lower normal limit or amplitude 10 min after CT (A10), Maximum clot firmness (MCF) in ROTEM measurement is above the upper normal limit of EXTEM, INTEM and FIBTEM. Results: 43% of CABG patients who were diagnosed as hypercoagulability state assessed by ROTEM. Mortality rate was slightly higher in hypercoagulable patients without statistical significance (9% vs 5.1%;P = 0.461). However, overall combined uneventful rate was significantly increased in hypercoagulable patients in 5 years follow-up (27.2% vs 8.6%;P = 0.012). In univariate analysis, ROTEM hypercoagulability is associated major adverse cardiovascular and cerebral event (MACCE) in 5-years follow up [OR (95% CI) = 3.975 (1.28 - 12.32);P = 0.017]. Conclusion: Hypercoagulable patients were identified 43 percent of patients associated with combine uneventful in 5 years follow-up. ROTEM could be applied as a useful tool in the prediction of outcome after CABG surgery.

Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis:A retrospective analysis

BACKGROUND Umbilical artery thrombosis(UAT)is extremely uncommon and leads to adverse perinatal outcomes.Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT.Ultrasound is an effective way to detect thrombosis.The mother can monitor her own fetal health using ultrasound,which enables her to take preventative action in case of emergency.AIM To investigate ultrasonic blood signal after UAT in the umbilical artery,and evaluate the relationship between hypercoagulability and UAT.METHODS We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow,and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital.Patients’information was collected from medical archives,including maternal clinical data,neonatal outcomes,pathological findings and ultrasonic indices of umbilical artery blood flow,such as systolic-diastolic duration ratio(S/D),resistance index(RI),pulsatility index(PI)and peak systolic velocity(PSV).Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R(version 4.2.1)including car(version 3.1-0)and stats(version 4.2.1),and visualized by ggplot2 package(version 3.3.6).RESULTS A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow(within 2.5th of reference ranges)in a short period of time.Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D,RI,and PI and increase of PSV during the disease process was greater than that of non-UAT.All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery,most of which(16/18)showed umbilical cord abnormalities,with 15 umbilical cord torsion and 1 pseudoknot.Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women.CONCLUSION Significant changes in ultrasound indicators after UAT were demonstrated.PSV can play important roles in the diagnosis of UAT.Hypercoagulability alone is not sufficient for the occurrence of UAT.

Shao Yao Decoction exerts a protective effect on ulcerative colitis by inhibiting inflammation mediated by hypercoagulability

Background:Shaoyao decoction(SYD)has been found widespread clinical use in treating ulcerative colitis(UC).However,the mechanism underlying SYD impact on UC remains elusive.Materials and methods:We preliminarily evaluated the therapeutic effect of SYD intervention in a dextran sulfate sodium-induced UC mouse model by analyzing the body weight change,disease activity index score,colon length,and HE staining results of colon tissue in each group of mice.Subsequently,we determined pro-inflammatory cytokines level and blood coagulation markers in the colon tissues of mice in each group to evaluate the effect of SYD intervention on colonic inflammatory response and coagulation function in UC mice.Results:Our findings emphasize the significant therapeutic effect of SYD on UC,including slowed down body weight loss,reduced disease activity index score,increased colon length,and reduced inflammatory infiltration in colon tissue.Moreover,SYD intervention significantly downregulated the levels of pro-inflammatory cytokines IL-1β,IL-6,and IL-17A in the colon.Furthermore,SYD intervention reversed the coagulation-related indicators such as prothrombin time,fibrinogen,P-selectin,D-dimer,and platelet glycomembrane protein IIb/IIIa.Conclusion:Our results elucidate the substantial therapeutic impact of SYD on UC mice.Importantly,the therapeutic mechanism of SYD in addressing UC potentially involves the inhibiting of inflammatory response mediated by hypercoagulability.

Ruptured Splenic Artery Aneurysm (SAA) in an Elderly Patient with Hypercoagulability: A Very Vague Presentation

Here, we discuss a 78-year-old woman with symptoms of shortness of breath and intermittent productive cough, which worsened over time. She had a history of Factor V Leiden and unprovoked pulmonary embolism (PE) and was on lifelong warfarin. The patient was found to have a widened mediastinum and a small left-sided pleural effusion on chest X-ray, leading to CT aortogram to assess for aortic pathology. While in the CT scanner, she experienced an acute deterioration and went into shock. The initial diagnosis was anaphylactic reaction to the contrast agent, but the CT images revealed an active bleeding in the left upper quadrant, possibly of splenic origin. The patient was stabilized with aggressive resuscitation measures and transferred to a referral hospital for urgent surgery. The surgery revealed a ruptured splenic artery aneurysm (SAA), and the patient was taken to the intensive care unit (ICU) for further management. However, she developed a large infarct in the left occipital lobe and passed away after six days. The case highlights the significance of recognizing the symptoms and signs of SAA and then taking a multidisciplinary approach in managing SAA patients, particularly those with hypercoagulability (Graphic 1).

possible role of soluble fibrin monomer complex after gastroenterological surgery

AIM To examine the role of soluble fibrin monomer complex(SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.METHODS We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.RESULTS A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five(28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7(OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/ml(AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to highSFMC patients who did not.CONCLUSION The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.

Internal carotid thrombus in patients with inflammatory bowel disease:Two cases

Increased ischemic stroke risk is observed in patients with inflammatory bowel disease(IBD).Causes and physiopathological aspects of cerebral infarct,in this specific population,are less often described.There is little information to provide guidelines for the best curative and preventive treatment.We report 2 cases of ischemic strokes due to internal carotid thrombus in patients during active phase of IBD.Ulceration of early atherosclerotic plaques activated by a hypercoagulation state may cause a thrombus.A combined therapy with heparin and corticosteroids was used for both our patients.Lysis of the thrombus was obtained after several days without surgical treatment and shown by ultrasonography.These cases highlight an aetiology of stroke in patients with IBD and use of a synergic treatment to respond to hypercoagulability in link with IBD. Benefits and safety of this therapy should be confirmed with clinical studies.

Coronavirus and cardiovascular manifestations-getting to the heart of the matter

Coronavirus disease has unarguably been the largest pandemic of recent times.Over 150 million cases have occurred worldwide,and more than 3 million have succumbed to the disease.Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis.The pathogenesis of myocardial damage could be direct or indirect,including inflammation,coronary spasm,plaque rupture,and cytokine storm.Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected.Hence,anticoagulation has also been a matter of debate.Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality.Management of cardiac patients with coronavirus disease 2019(COVID-19)infection is not considerably different from non-COVID-19 cardiovascular disease,but interaction between cardiovascular drugs and anti-COVID-19 therapy requires careful attention.More recently,vaccines have emerged as a ray of hope for the disease.But simultaneously,there have been reports of thromboembolism following vaccination.In this review,we discuss the various aspects of coronavirus disease affecting of heart and its management.

Hyperfibrinogenemia and Reduced Plasma Protein C Levels in HIV-Infected Patients

Background: Heamatological problems have been associated with human immunodeficiency virus infection. Hypercoagulability, in particular, thrombosis is becoming more common in HIV-positive patients. Aim: The goals of this study were to determine levels of plasma fibrinogen, protein C, Hemoglobin, and ESR among Sudanese HIV-positive patients. Materials and Methods: This is a case-control study, for this investigation, a total of 100 participants were recruited for this study. Fifty people were diagnosed with HIV, 25 of whom were males (50 percent) and 25 of whom were females (50 percent), with an average age of 35.5 years. Further fifty healthy people, 26 (52%) of whom were men and 24 (48%) of whom were women, with a mean age of 37.1 years, matched the case group. Fresh Poor Plasma was obtained by centrifuging citrated venous blood samples at 3000 rpm for 15 minutes. The fibrinogen level was determined using an automated coagulation analyzer. Total protein C level was measured by a fully-automated blood coagulation analyzer (SYSMEX CA-500’JAPAN). The haemoglobin parameter was measured from EDTA anticoagulant samples using the Sysmex KX 21-N automated haematological analyzer. In one hour, the ESR was done using a Westergren tube. Data was collected using a structured direct questionnaire. SPSS version 21 was used to analyse the data. Results: The current study discovered that in Sudanese HIV infection, the mean and standard deviation of plasma fibrinogen levels were statistically substantially higher than in the normal control group (370.5 ± 67 vs 214.7 ± 21 with P value 0.001). Protein C levels were statistically significantly lower in HIV positive patients compared with control group (0.6 ± 0.1 vs 1.3 ± 0.2 with P value 0.001). In HIV positive patients, haemoglobin was statistically substantially lower than in healthy people (10.8 ± 1.8 vs 13.7 ± 1.9, P value 0.01). The erythrocyte sedimentation rate was statistically significantly higher in HIV positive patients than in the control group, with (58.00 ± 27 vs 7.68 ± 3 with P value 0.00). Conclusions: HIV infected patients had higher plasma fibrinogen levels and lower haemoglobin levels than normal healthy control groups. In 16 percent of HIV positive patients, protein C deficiency was discovered. HIV-positive patients had significantly greater ESR.

Tuberculosis Presenting as Multiple Vein Thrombosis in a Hospitalized Man

Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism (VTE) is a rare complication of this disease, it may be a potentially life-threatening event. A 58-year-old man was admitted due to hematemesis due to inflammation at the anastomosis site after a gastrectomy years ago. After 3 days in-hospital, he showed a peroneal deep vein thrombosis and superficial thrombosis of left cephalic vein. Although reduced mobility and lack of prophylactic heparin could explain vein thrombosis, a simple etiologic workup was performed and active tuberculosis was diagnosed. This case illustrates a rare and unusual presentation form of tuberculosis, a condition that remains now-a-days one of the leading infectious causes of death worldwide. The association between tuberculosis and VTE is rare, but it should be systematically investigated.

Stroke as a Presenting Feature of COVID-19

Objective: To analyze the coronavirus disease-2019 (COVID-19) patients presenting with acute stroke by determining their clinical characteristics, hospitalization course and prognosis. The common and conventional stroke risk factors in these patients were assessed with the aim of determining the role and contribution of the COVID-19 infection to stroke pathogenesis. Methods: Retrospective observational study involving 24 patients from a single tertiary care center over a time period of three months. Risk factors such as Age, Hypertension, Diabetes Mellitus, smoking status and underlying cardiac history were analyzed. COVID-19 relevant laboratory and radiological data were documented. Results: 87.5% of patients had ischemic stroke, with 58.3% of total patients being younger than 55 years. An equal incidence of both Diabetes Mellitus and Hypertension (37.5%) was identified. 29.2% were completely asymptomatic for COVID-19, of which 85.7% had no chest X-ray changes on admission. Eight patients (61.5%) developed pneumonia during admission despite an initially normal chest X-ray. Conclusion: Patients without COVID-19 symptoms and with normal chest radiography presenting with stroke does not rule out a possible underlying COVID-19 infection. Such patients may be positive for the virus and may go on to develop pneumonia shortly after suffering from strokes. This could suggest that stroke in COVID-19 patients is a possible initial presenting feature and consequence of the inflammatory state triggered by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. It is imperative to analyze the association of COVID-19 and stroke, and to maintain a high index of suspicion of COVID-19 infection in stroke patients, to enhance early detection and reduce transmission.

A Case Report and a Descriptive Retrospective Study of Cases of Inferior Vena Cava Thrombosis Diagnosed over a 10-Year Period in a Third Level Hospital

Inferior vena cava thrombosis is an under-recognized entity associated with significant morbidity and mortality. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Regarding this condition, we present the case of a 63-year-old man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. After several tests, including magnetic resonance imaging (MRI), he was diagnosed to have agenesis of left renal vein and inferior vena cava thrombosis, from hypercoagulable state secondary to Antiphospholipid Syndrome. He had anticoagulation treatment with low-molecular-weight heparin with good subsequent evolution. This study sets out a descriptive retrospective study of fifty cases of inferior vena cava thrombosis diagnosed in a third-level hospital in the north of Spain over a ten-year period (2010-2018). The aim of this article is to identify the epidemiology, predisposing factors and symptoms that characterize this entity, in order to be able to achieve an early diagnosis that allows us to initiate immediate treatment, minimizing acute and chronic complications of this disease.

When neurological symptoms hides a nephrologic pathology and a cardiac abnormality

We bring report the case of a young woman who presents with neurological symptoms, and to which the practised investigations led to the discovery in chain of unexpected pathologies. These neurological disorders were revealing of the picture associating a nephrotic syndrome and a patent foramen ovale. This foramen was the major route of a rain of emboles ring peripheral favored by the nephrotic syndrome towards the cerebral hemispheres.

A Correlation Analysis of Postoperative Hypercoagulability and Peripheral Circulating Tumor Cells in Patients with Lung Cancer

Objective:To explore the correlation between peripheral circulating tumor cells and hypercoagulability in patients with lung cancer after surgery.Methods:From January 2017 to December 2021,89 patients with lung cancer who were treated in the Affiliated Hospital of Hebei University were selected as the research subjects,and a retrospective analysis was conducted to analyze and observe the D-dimer(DD),fibrinogen(FIB),and platelet(PLT)levels in peripheral blood,as well as detect peripheral CTC.Results:There were statistical differences in TMN staging,tumor metastasis,and lymph node metastasis in the clinical data,but there were no statistical differences in gender,smoking history,and pathological classification.After retrospective analysis and comparison of the patients,the DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels of the CTC positive group were 3.41±0.58,3.98±0.87,and 367.26±34.98,respectively;the CTC negative group’s DD(mg/ml),FIB(g/L),and PLT(×10^(9)/L)levels were 0.89±0.49,1.06±0.45,and 234.69±35.69,respectively,and the differences were statistically significant.The factors affecting the prognosis of patients included TMN staging and CTC;the number of CTC positives in the death group was significantly higher than that in the survival group,and there was a statistical difference between the groups.Gender,age,smoking history,pathological type,and surgical resection had no effect on the prognosis of patients.Among the enrolled patients,the survival rate was 71.91%.Conclusion:CTC-positive patients have a higher probability of hypercoagulability after surgery and are prone to tumor metastasis;thus,CTC can be used as a judgment index for the prognosis of patients.

Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic decompensation.Portal flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT development.However,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still elusive.In particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as yet.Moreover,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction progression.Anticoagulation and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still unknown.Nevertheless,their impact on mortality rates should be addressed more extensively.In this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.

Inflammatory bowel disease:Epidemiology,pathology and risk factors for hypercoagulability

Hypercoagulability observed in patients with inflammatory bowel diseases(IBD)may lead to thromboembolic events(TE),which affect the venous and arterial systems alike and are an important factor in patients’morbidity and mortality.The risk of TE in IBD patients has been demonstrated to be approximately threefold higher as compared to the general population.The pathogenesis of thrombosis in IBD patients is multifactorial and not fully explained.The most commonly listed factors include genetic and immune abnormalities,disequilibrium between procoagulant and anticoagulant factors,although recently,the role of endothelial damage as an IBD-triggering factor is underlined.Several studies report that the levels of some coagulation enzymes,including fibrinogen,factorsⅤ,Ⅶ,Ⅷ,active factorⅪ,tissue factor,prothrombin fragment 1+2and the thrombin-antithrombin complex,are altered in IBD patients.It has been demonstrated that there is a significant decrease of tissue plasminogen activator level,a marked increase of plasminogen activator inhibitor type 1 and thrombin-activable fibrinolysis inhibitor,a significantly lower level of antithrombinⅢand tissue factor pathway inhibitor.IBD patients have been also observed to produce an increased amount of various anticoagulant antibodies.Hyperhomocysteinemia,which is a potential risk factor for TE was also observed in some IBD patients.Further studies are necessary to assess the role of coagulation abnormalities in IBD etiology and to determine indications for thromboprophylactic treatment in patients at high risk of developing TE.

Variations and Clinical Significance of Coagulation and Fibrinolysis Parameters in Patients with Diabetes Mellitus

We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type Ⅱ diabetic patients. Subjects consisted of 22 patients with type Ⅱ diabetes mellitus and 25 healthy controls. Compared with the control, activated partial thrombo-plastin time, prothrombin time were shortened in the patients. The diabetic subjects also displayed higher levels of D-dimer, serum fibrin degradation products, median concentrations of fibrinogen (3. 99 vs 2. 96 g/L, P<0. 01) and von Wille-brand factor (149 % vs 87 %, P<0. 01). Levels of anfithrombin Ⅲ activity or antigen were not different from control values. Simple linear regression analysis revealed a negative correlation between antithrombin Ⅲ activity and fast blood glucose. Diabetic patients with vascular complications had significantly higher levels of fibrinogen and D-dimer than those without diabetic angiopathy. Our data demonstrated that patients with type Ⅱ diabetes mellitus had a hypercoagulable state. We believed the activation of coagulation might contribute to the vascular complications in diabetics.

A case of portal vein thrombosis associated with acute cholecystitis/pancreatitis or coincidence

BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervention. PVT is commonly forgotten as a possible cause of abdominal pain. The clinical picture may vary but abdominal pain and low grade fever are the most characteristic picture. METHODS: A 58-year-old male patient was admitted to our hospital complaining of abdominal pain for three days. CT scan revealed an edematous area around the portal vein. Doppler ultrasonography showed evidence of a portal vein thrombosis. RESULTS: PVT can be diagnosed with CT and Doppler ultrasonography. Fresh thrombus can be undetected by sonography because of the low echogenity but can be recognised by color Doppler ultrasonography. Treatment ranges from observation and bowel rest to surgical resection of bowel. CONCLUSIONS: When we suspect a case of PVT, it should be treated at an early stage to prevent being lost in a diagnostic dilemma. The immediate use of anticoagulant could be important in preventing serious consequences of PVT.

Detection of the Level of Urinary FPA in Chronic Nephritis with Renal Failure and Its Clinical Implication

The level of urinary FPA was assayed by high per formance liquid chromatography (HPLC ) in 42 normal controls, 57 cases of chronic glomeru-lonephritis, including 24 with normal renal function, 12 with renal insufficiency and 21 with uremia. Their levels were 24. 40± 10. 30 μg/L, 26. 99±5.77 μg/L,38. 81±6. 28 μg/L, 79. 74± 18. 76 μg/L, respectively. The level of urinary FPA in renal insufficiency function group was significantly higher than those of the con-trol group and normal renal function group (P<0.01). The patients with uremia presented dramatically higher level of urinary FPA than those in the renal insufficiency group (P<0.01). A positive correlation was found between the level of urinary FPA and the blood creatine (r= 0. 9120, P<0. 01 ). It was suggested that a hypercoagulable state existed in the patients with chronic nephritis with renal failure, in which the severity was closely related with the occurrence and development of the disease. The urinary FPA could serve as a good indicator for renal function.