Florence Aulagnon1, Nathanael Lapidus2, Emmanuel Canet1, Lionel Galicier3, David Boutboul3, Marie-Noelle Peraldi4, Danielle Reuter1, Remy Bernard1, Benoit Schlemmer1, Elie Azoulay1, Lara Zafrani5. 1. Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France. 2. Biostatistics Department, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne University, Pierre et Marie Curie University, Paris, France. 3. Department of Clinical Immunology, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France. 4. Department of Nephrology, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France. 5. Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France. Electronic address: lara.zafrani@sls.aphp.fr.
Abstract
BACKGROUND: Acute kidney injury (AKI) in the setting of hemophagocytic lymphohistiocytosis (HLH) is poorly characterized. This study aims to describe the incidence, clinical and biological features, and outcome associated with AKI in this population. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: Patients with secondary HLH admitted to a single center from February 2007 through January 2013. 95 patients were included in the study. PREDICTOR: AKI. OUTCOMES: Recovery of kidney function, 6-month mortality, and complete remission of the underlying disease. MEASUREMENTS: AKI was defined according to the KDIGO 2012 guideline. Recovery of kidney function was defined as improvement in serum creatinine level, with return to baseline serum creatinine level ±26.5μmol/L. RESULTS: HLH was related to hematologic malignancy in 73 (77%), infectious disease in 21 (22%), and autoimmune disease in 9 (10%) patients and was multifactorial in 10 (11%) patients. The cause was undetermined in 2 (2%) patients. The incidence of AKI during HLH is high (62%), and 59% of the AKI population required renal replacement therapy. Main causes of AKI were acute tubular necrosis (49%), hypoperfusion (46%), tumor lysis syndrome (29%), or HLH-associated glomerulopathies (17%). At 6 months, 32% of the patients with AKI had chronic kidney disease. Two factors were associated independently with 6-month mortality by multivariable analysis: AKI stage ≥ 2 (OR, 2.61; 95% CI, 1.08-6.29; P=0.03) and an underlying hematologic malignancy (OR, 3.1; 95% CI, 1.05-9.14; P=0.04). In patients with hematologic malignancy, AKI was associated with lower 6-month complete remission (non-AKI, 25%; AKI patients, 5%; P=0.05). LIMITATIONS: Retrospective study, lack of histologic data. CONCLUSIONS: AKI in patients with HLH is frequent and adversely affects remission and survival. Early intensive management, including administration of etoposide, nephrotoxic drug withdrawal, prevention of tumor lysis syndrome, or aggressive supportive care, might improve kidney function and survival.
BACKGROUND:Acute kidney injury (AKI) in the setting of hemophagocytic lymphohistiocytosis (HLH) is poorly characterized. This study aims to describe the incidence, clinical and biological features, and outcome associated with AKI in this population. STUDY DESIGN: Case series. SETTING & PARTICIPANTS: Patients with secondary HLH admitted to a single center from February 2007 through January 2013. 95 patients were included in the study. PREDICTOR: AKI. OUTCOMES: Recovery of kidney function, 6-month mortality, and complete remission of the underlying disease. MEASUREMENTS: AKI was defined according to the KDIGO 2012 guideline. Recovery of kidney function was defined as improvement in serum creatinine level, with return to baseline serum creatinine level ±26.5μmol/L. RESULTS: HLH was related to hematologic malignancy in 73 (77%), infectious disease in 21 (22%), and autoimmune disease in 9 (10%) patients and was multifactorial in 10 (11%) patients. The cause was undetermined in 2 (2%) patients. The incidence of AKI during HLH is high (62%), and 59% of the AKI population required renal replacement therapy. Main causes of AKI were acute tubular necrosis (49%), hypoperfusion (46%), tumor lysis syndrome (29%), or HLH-associated glomerulopathies (17%). At 6 months, 32% of the patients with AKI had chronic kidney disease. Two factors were associated independently with 6-month mortality by multivariable analysis: AKI stage ≥ 2 (OR, 2.61; 95% CI, 1.08-6.29; P=0.03) and an underlying hematologic malignancy (OR, 3.1; 95% CI, 1.05-9.14; P=0.04). In patients with hematologic malignancy, AKI was associated with lower 6-month complete remission (non-AKI, 25%; AKI patients, 5%; P=0.05). LIMITATIONS: Retrospective study, lack of histologic data. CONCLUSIONS: AKI in patients with HLH is frequent and adversely affects remission and survival. Early intensive management, including administration of etoposide, nephrotoxic drug withdrawal, prevention of tumor lysis syndrome, or aggressive supportive care, might improve kidney function and survival.
Authors: Christian Nusshag; Christian Morath; Martin Zeier; Markus A Weigand; Uta Merle; Thorsten Brenner Journal: Medicine (Baltimore) Date: 2017-12 Impact factor: 1.817