• Florence Aulagnon, Nathanael Lapidus, Emmanuel Canet, Lionel Galicier, David Boutboul, Marie-Noelle Peraldi, Danielle Reuter, Remy Bernard, Benoit Schlemmer, Elie Azoulay, and Lara Zafrani.
• Medical Intensive Care Unit, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, and Paris Diderot University, Paris, France.
• Am. J. Kidney Dis. 2015 Jun 1;65(6):851-9.

BackgroundAcute 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 DesignCase series.Setting & ParticipantsPatients with secondary HLH admitted to a single center from February 2007 through January 2013. 95 patients were included in the study.PredictorAKI.OutcomesRecovery of kidney function, 6-month mortality, and complete remission of the underlying disease.MeasurementsAKI 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.ResultsHLH 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).LimitationsRetrospective study, lack of histologic data.ConclusionsAKI 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.Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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