title: Acute kidney injury in adults with hemophagocytic lymphohistiocytosis.
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.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Patients with secondary HLH admitted to a single center from February 2007 through January 2013. 95 patients were included in the study.
  
  
  METHODS
  AKI.
  
  
  RESULTS
  Recovery of kidney function, 6-month mortality, and complete remission of the underlying disease.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Aulagnon
authors.affiliation: 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.
authors.forename: Nathanael
authors.initials: N
authors.lastname: Lapidus
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.affiliation: Department of Clinical Immunology, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.affiliation: Department of Clinical Immunology, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Boutboul
authors.affiliation: Department of Nephrology, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Marie-Noelle
authors.initials: MN
authors.lastname: Peraldi
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Danielle
authors.initials: D
authors.lastname: Reuter
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Bernard
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Schlemmer
authors.affiliation: Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: 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.
authors.forename: Lara
authors.initials: L
authors.lastname: Zafrani
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D015331:Cohort Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015275:Tumor Lysis Syndrome / Q000150:complications*
keywords: AKI etiology; Hemophagocytosis; acute kidney injury (AKI); hematological malignancy; hemophagocytic lymphohistiocytosis (HLH); kidney disease outcome; mortality; prognosis; remission; renal failure; renal replacement therapy (RRT)