Advertisement

The Pathophysiologic and Therapeutic Role of Platelet and Vascular Arachidonic Acid Metabolites in Renal Failure

  • Michael C. Smith
  • Michael J. Dunn

Abstract

Both acute and chronic renal insufficiency are associated with prolonged bleeding times and an increased incidence of cutaneous and gastrointestinal hemorrhage.1–3 This uremic bleeding tendency has been attributed to a qualitative platelet abnormality characterized by decreased platelet adhesiveness, impaired aggregation in response to adenosine diphosphate (ADP) and thrombin, and diminished platelet factor 3 release.4,5 While some reports1,6 have demonstrated that the platelet defect improves or normalizes with dialysis, others7,8 have not.

Keywords

Platelet Aggregation Platelet Function Bleeding Time Arachidonic Acid Metabolite Serum Urea Nitrogen 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Stewart JH, Castaldi PA: Uraemic bleeding: A reversible platelet defect corrected by dialysis. Q J Med 36: 409–423, 1967.PubMedGoogle Scholar
  2. 2.
    Eknoyan G, Wacksman SJ, Glueck FII, et al: Platelet function in renal failure. N Engl J Med 280: 677–681, 1969.PubMedCrossRefGoogle Scholar
  3. 3.
    Fried W: Hematologic complications of chronic renal failure. Med Clin North Am 62: 1363–1379, 1978.PubMedGoogle Scholar
  4. 4.
    Castaldi PA, Rozenberg MC, Stewart JH: The bleeding disorder of uraemia. Lancet 2: 66–69, 1966.PubMedCrossRefGoogle Scholar
  5. 5.
    Horowitz HI: Uaemic toxins and platelet function. Arch Intern Med 126: 832–826, 1970.CrossRefGoogle Scholar
  6. 6.
    Remuzzi G, Livio M, Marchiaro G, et al: Bleeding in renal failure: Altered platelet function in chronic uraemia only partially corrected by hemodialysis. Nephron 22: 347–353, 1978.PubMedCrossRefGoogle Scholar
  7. 7.
    Lindsay RM, Moorthy AV, Koens F, et al: Platelet function in dialyzed and non-dialyzed patients with chronic renal failure. Clin Nephrol 4: 52–57, 1975.PubMedGoogle Scholar
  8. 8.
    Nenci GG, Berrettini M, Agnelli G, et al: Effect of peritoneal dialysis, haemodialysis and kidney transplantation on blood platelet function. I. Platelet aggregation by ADP and epinephrine. Nephron 23: 287–292, 1979.PubMedCrossRefGoogle Scholar
  9. 9.
    Moncada S, Vane JR: Arachidonic acid metabolites and the interactions between platelets and blood-vessel walls. N Engl J Med 300: 1142–1147, 1979.PubMedCrossRefGoogle Scholar
  10. 10.
    Gorman R: Modulation of human platelet function by prostacyclin and thromboxane A2. Fed Proc 38: 83–88, 1979.PubMedGoogle Scholar
  11. 11.
    Remuzzi G, Mecca G, Cavenghi AE, et al: Prostacyclin-like activity and bleeding in renal failure. Lancet 2: 1195–1197, 1977.PubMedCrossRefGoogle Scholar
  12. 12.
    Silberbauer K, Sinzinger H, Winter M: Increased prostacyclin (PGI2) availability of vascular tissue in experimentally-induced acute uremic rats. Artery 4: 554–563, 1978.Google Scholar
  13. 13.
    Remuzzi G, Livio M, Cavenaghi AE, et al: Unbalanced prostaglandin synthesis and plasma factors in uraemic bleeding. A hypothesis. Thromb Res 13: 531–536, 1978.PubMedCrossRefGoogle Scholar
  14. 13.
    Remuzzi G, Livio M, Cavenaghi AE, et al: Unbalanced prostaglandin synthesis and plasma factors in uraemic bleeding. A hypothesis. Thromb Res 13: 531–536, 1978.PubMedCrossRefGoogle Scholar
  15. 15.
    Packham MA, Mustard JF: Clinical pharmacology of platelets. Blood 50: 555–573, 1977.PubMedGoogle Scholar
  16. 16.
    Born GVR: Aggregation of blood platelets by adenosine diphosphate and its reversal. Nature 194: 927–929, 1962.PubMedCrossRefGoogle Scholar
  17. 17.
    Mielke CH, Kaneshiro MM, Maher IA, et al: The standardized normal Ivy bleeding time and its prolongation by aspirin. Blood 34: 204–215, 1969.PubMedGoogle Scholar
  18. 18.
    Lindsay RM, Friesen M, Aronstam A, et al: Improvement of platelet function by increased frequency of hemodialysis. Clin Nephrol 10: 67–70, 1978.PubMedGoogle Scholar
  19. 19.
    Jorgensen KA, Ingeberg S: Platelets and platelet function in patients with chronic uremia on maintenance hemocialysis. Nephron 23: 233–236, 1979.PubMedCrossRefGoogle Scholar
  20. 20.
    Remuzzi G, Livio M, de Gaetano G: Platelet and vascular prostaglandins in uremic bleeding. Min Elec Metab 6: 68–75, 1981.Google Scholar
  21. 21.
    Smith MC, Park GD, Hassid A, et al: The effect of prostacyclin on platelet aggregation and plasma 6-keto-prostaglandin Fla concentration during hemodialysis. Submitted for publication.Google Scholar
  22. 22.
    Evans EP, Branch RA, Bloom AL: A clinical and experimental study of platelet function in chronic renal failure. J Clin Pathol 25: 745–753, 1972.PubMedCrossRefGoogle Scholar
  23. 23.
    Rabiner SF: The effect of dialysis on platelet function of patients with renal failure. Ann NY Acad Sci 201: 234–242, 1972.PubMedCrossRefGoogle Scholar
  24. 24.
    Janson PA, Jubelirer SJ, Weinstein MJ, et al: Treatment of the bleeding tendency in uremia with cryoprecipitate. N Engl J Med 303: 1318–1322, 1980.PubMedCrossRefGoogle Scholar
  25. 25.
    Lindsay RM, Friesen M, Koens F, et al: Platelet function in patients on long term peritoneal dialysis. Clin Nephrol 6: 335–339, 1976.PubMedGoogle Scholar
  26. 26.
    Lindsay RM, Prentice CRM, Davidson JG, et al: Haemostatic changes during dialysis associated with thrombus formation on dialysis membranes. B Med J 4: 454–458, 1972.CrossRefGoogle Scholar
  27. 27.
    Zucker WH, Shinoda BA, Mason RG: Experimental interactions of components of hemodialysis units with human blood. Am J Pathol 75: 139–156, 1974.PubMedGoogle Scholar
  28. 28.
    Marshall JW, Ahearn DJ, Nothum RJ, et al: Adherence of blood components to dialyzer membranes morphological studies. Nephron 12: 157–170, 1974.PubMedCrossRefGoogle Scholar
  29. 29.
    Walsh PN: Platelet coagulant activities and hemostasis: A hypothesis. Blood 43: 597–605, 1974.PubMedGoogle Scholar
  30. 30.
    Zucker MB: Biological aspects of heparin action. Heparin and platelet function. Fed Proc 36: 47–49, 1977.PubMedGoogle Scholar
  31. 31.
    Leonard A, Shapiro FL: Subdural hematoma in regularly hemodialyzed patients. Ann Intern Med 82: 650–658, 1975.PubMedGoogle Scholar
  32. 32.
    Galen MA, Steinberg SM, Lowrie EG, et al: Hemorrhagic pleural effusion in patients undergoing chronic hemodialysis. Ann Intern Med 82: 359–361, 1975.PubMedGoogle Scholar
  33. 33.
    Milutinovich J, Follette WC, Scribner BH: Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis. Ann Intern Med 86: 189–192, 1977.PubMedGoogle Scholar
  34. 34.
    Gryglewski RJ, Bunting S, Moncada S, et al: Arterial walls are protected against deposition of platelet thrombi by a substance (prostaglandin X) which they make from prostaglandin endoperoxides. Prostaglandins 12: 685–713, 1976.PubMedCrossRefGoogle Scholar
  35. 35.
    Dusting GJ, Moncada S, Vane JR: Disappearance of prostacyclin (PGI2) in the circulation of the dog. Br J Pharmacol 62: 414P - 415P, 1978.PubMedGoogle Scholar
  36. 36.
    Woods HF, Ash G, Weston MJ, et al: Prostacyclin can replace heparin in hemodialysis in dogs. Lancet 2: 1075–1077, 1978.PubMedCrossRefGoogle Scholar
  37. 37.
    Longmore DB, Bennett G, Gueirrara D, et al: Prostacyclin: A solution to some problems of extracorporeal circulation. Lancet 1: 1002–1005, 1979.PubMedCrossRefGoogle Scholar
  38. 38.
    Gimson AES, Langley PG, Hughes RD, et al: Prostacyclin to prevent platelet activation during charcoal haemoperfusion in fulminant hepatic failure. Lancet 1: 173–175, 1980.PubMedCrossRefGoogle Scholar
  39. 39.
    Tumey JH, Williams LC, Fewell MR, et al: Platelet protection and heparin sparing with prostacyclin during regular dialysis therapy. Lancet 2: 219–222, 1980.Google Scholar
  40. 40.
    Smith MC, Danviriyasup K, Cato AE, et al: Prostacyclin substitution for heparin in hemodialysis. Kidney Int 19: 159, 1981.Google Scholar
  41. 41.
    Zusman RM, Rubin RH, Cato AE, et al: Hemodialysis using prostacyclin instead of heparin as the sole antithrombotic agent. N Engl J Med 304: 934–939, 1981.PubMedCrossRefGoogle Scholar
  42. 42.
    Henderson LW: Hemodialysis, in Earley LE, Gottschalk CW (eds): Strauss and Welt’s Diseases of the Kidney. Boston, Little, Brown and Company, 1979, pp 421–462.Google Scholar
  43. 43.
    Glaser P, Guesde R, Rouby JJ, et al: Haemodialysis without heparin is possible. Lancet 2: 579–580, 1979.PubMedCrossRefGoogle Scholar
  44. 44.
    Swartz RD, Port FK: Preventing hemorrhage in high-risk hemodialysis: Regional versus low-dose heparin. Kidney Int 16: 513–518, 1979.PubMedCrossRefGoogle Scholar
  45. 45.
    O’Grady J, Warrington S, Moti MJ, et al: Effects of intravenous infusion of prostacyclin (PGI2) in man. Prostaglandins 19: 319–332, 1980.PubMedCrossRefGoogle Scholar
  46. 46.
    Kirkendol PL, Denia CJ, Bower JD, et al: A comparison of the cardiovascular effects of sodium acetate, sodium bicarbonate and other potential sources of fixed base in hemodialysate solutions. Trans Am Soc Artif Int Organs 23: 399–404, 1977.CrossRefGoogle Scholar
  47. 47.
    Gryglewski RJ, Szczeklik A, Nizankowski R: Anti-platelet action of intravenous infusion of prostacyclin in man. Thromb Res 13: 153–163, 1978.PubMedCrossRefGoogle Scholar
  48. 48.
    Patak RV, Wiegmann TB, Diederich DA: Effect of prostacyclin (PGI2) on urea clearance (U0) in conscious dog. Kidney Int 19: 155, 1981.Google Scholar
  49. 49.
    Cazanave JP, Dejana E, Kinlough-Rathbone RL, et al: Prostaglandins I2 and E1 reduce rabbit and human platelet adherence without inhibiting serotonin release from adherent platelets. Thromb Res 15: 273–279, 1979.CrossRefGoogle Scholar
  50. 50.
    Lindgren JA, Claesson HE, Kindahl H, et al: Effects of platelet aggregation and adenosine 3’:5’monophosphate on the synthesis of thromboxane B2 in human platelets, in Samuelsson B, Ramwell PW, Paoletti R (eds): Advances in Prostaglandin and Thromboxane Research. New York, Raven Press, 1980, vol 6, pp 275–281.Google Scholar
  51. 51.
    Addonizio VP, Smith JB, Guiod LR, et al: Thromboxane synthesis and platelet protein release during simulated extracorporeal circulation. Blood 54: 371–376, 1979.PubMedGoogle Scholar
  52. 52.
    Lapetina EG, Cuatrecasas P: Rapid inactivation of cyclo-oxygenase activity after stimulation of intact platelets. Proc Nat Acad Sci USA 76: 121–125, 1979.PubMedCrossRefGoogle Scholar
  53. 53.
    Charo IF, Feinman RD, Detwiler TC: Interrelations of platelet aggregation and secretion. J Clin Invest 60: 866–873, 1977.PubMedCrossRefGoogle Scholar
  54. 54.
    Salzman EW, Rosenberg RD, Smith MH, et al: Effect of heparin and heparin fractions on platelet aggregation. J Clin Invest 65: 64–73, 1980.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1983

Authors and Affiliations

  • Michael C. Smith
    • 1
    • 2
  • Michael J. Dunn
    • 1
    • 2
  1. 1.Department of MedicineCase Western Reserve UniversityClevelandUSA
  2. 2.Division of NephrologyUniversity Hospitals of ClevelandClevelandUSA

Personalised recommendations