Fibrinogen degradation products in acute renal failure of the newborn.

Acute parenchymal renal failure (ARF) in the newborn infant has emerged as a major problem since the advent of neonatal intensive care units. Because intravascular and/or intrarenal coagulation may be important in the development of ARF, a prospective study of coagulation was performed on 20 babies with ARF, with particular emphasis on the measurement of fibrinogen degradation products (FDP) in serum and urine. Thirteen babies with respiratory distress syndrome (RDS) and 40 healthy neonates served as controls. Initial serum FDP levels were significantly higher in ARF than in RDS or normals (P less than 0.001); initial urine FDP levels were higher in ARF than in normals (P less than 0.01). Levels of FDP did not differentiate among the various etiologies of ARF. Since initial urine FDP levels are high in normal newborns, serial urine FDP were compared among patient groups and found to be highest in ARF. Initial serum and urine FDP levels could not differentiate among the 11 survivors and 9 nonsurvivors, but FDP levels declined as the duration of ARF (e.g., survival) increased, often antedating the recovery of renal function. We conclude: (1) serum and urine FDP are significantly elevated in most newborns with ARF; (2) factors other than hypoxia may be involved in the pathogenesis of elevated serum FDP in RDS with ARF newborns, indicating the importance of coagulation; (3) serial measurements of serum and urine FDP may be early indicators of recovery of renal function.