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The role of coagulation fibrinolytic system in diabetic vascular complications 1. urine factor excretion in diabetics and its role in the intra glomerular coagulation



The role of coagulation fibrinolytic system in diabetic vascular complications 1. urine factor excretion in diabetics and its role in the intra glomerular coagulation



Acta Haematologica Japonica 43(4): 715-722



The procoagulant substance in human urine (urine factor, UF) is chiefly derived from the renal tissue thromboplastin. The urine of healthy subjects and diabetics was purified, the recalcification time for each UF measured, and its thromboplastin level calculated from the calibration curve as UF excretion (mg/day). The urinary excretion of UF was not related to age, sex, fasting blood sugar, daily urine volume, daily urine sugar excretion or daily urine protein output, but inversely correlated with duration of diabetes and correlated with endogenous creatinine clearance value. The longer the duration of diabetes, the more the UF excretion tended to decrease. The mean UF excretion was 3.73 mg/day in the macroangiopathic type group (group B), which coincided closely with 3.51 mg/day in the normal control group (group A), while it was decreased to 1.62 mg/day in the microangiopathic type group (group C). The mean UF excretion in the secondary diabetes group (group D) was as high as 4.05 mg/day, but it was decreased in the patients with long duration. The mean UF excretion of patients under diet therapy was 5.74 mg/day, that of patients treated with antidiabetic agents was 3.2 mg/day, that of patients treated with insulin was 1.52 mg/day and that of patients treated with warfarin in combination with insulin was 2.31 mg/day. Intraglomerular coagulation may proceed actively in mild diabetes at the early stage, and inactively at the advanced stage. The development of the coagulation dominant phase into the advanced changes might be prevented by suppressing the persistent coagulation dominant phase over a long period by anticoagulant therapy in combination with antidiabetic therapy.

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