Acute kidney injury in critical care: complications of hemophagocytic lymphohistiocytosis

被引:0
作者
Zhao, Mengya [1 ]
Guan, Yiming [2 ]
Lin, Jin [1 ]
Qiu, Yu [1 ]
Zhao, Shen [1 ]
Duan, Meili [1 ]
机构
[1] Capital Med Univ, Beijing Friendship Hosp, Dept Crit Care Med, Beijing, Peoples R China
[2] Capital Med Univ, Beijing Friendship Hosp, Dept Nephrol, Beijing, Peoples R China
来源
FRONTIERS IN IMMUNOLOGY | 2024年 / 15卷
关键词
hemophagocytic lymphohistiocytosis; acute kidney injury; sepsis; critical care; intensive care unit; MACROPHAGE ACTIVATION SYNDROME; CASE SERIES; SOLUBLE INTERLEUKIN-2-RECEPTOR; GLYCOSYLATED FERRITIN; SERUM PROCALCITONIN; RENAL-INSUFFICIENCY; PROGNOSTIC-FACTORS; DIAGNOSTIC-VALUE; DISEASE; ADULTS;
D O I
10.3389/fimmu.2024.1396124
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Hemophagocytic lymphohistiocytosis (HLH) is an immune dysfunction characterized by an exaggerated and pathological inflammatory response, potentially leading to systemic inflammatory reactions and multiple-organ failure, including renal involvement. HLH can be classified as primary or secondary, with primary HLH associated with genetic mutations affecting cell degranulation capacity, and secondary HLH often linked to infections, tumors, and autoimmune diseases. The pathogenesis of HLH is not fully understood, but primary HLH is typically driven by genetic defects, whereas secondary HLH involves the activation of CD8+ T cells and macrophages, leading to the release of inflammatory cytokines and systemic inflammatory response syndrome (SIRS). The clinical presentation of HLH includes non-specific manifestations, making it challenging to differentiate from severe sepsis, particularly secondary HLH due to infections. Shared features include prolonged fever, hepatosplenomegaly, hematopenia, hepatic dysfunction, hypertriglyceridemia, and hypofibrinogenemia, along with histiocytosis and hemophagocytosis. However, distinctive markers like dual hemocytopenia, hypertriglyceridemia, hypofibrinogenemia, and elevated sCD25 levels may aid in differentiating HLH from sepsis. Indeed, no singular biomarker effectively distinguishes between hemophagocytic lymphohistiocytosis and infection. However, research on combined biomarkers provides insights into the differential diagnosis. Renal impairment is frequently encountered in both HLH and sepsis. It can result from a systemic inflammatory response triggered by an influx of inflammatory mediators, from direct damage caused by these factors, or as a consequence of the primary disease process. For instance, macrophage infiltration of the kidney can lead to structural damage affecting various renal components, precipitating disease. Presently, tubular necrosis remains the predominant form of renal involvement in HLH-associated acute kidney injury (HLH-AKI). However, histopathological changes may also encompass interstitial inflammation, glomerular abnormalities, microscopic lesions, and thrombotic microangiopathy. Treatment approaches for HLH and sepsis diverge significantly. HLH is primarily managed with repeated chemotherapy to eliminate immune-activating stimuli and suppress hypercellularity. The treatment approach for sepsis primarily focuses on anti-infective therapy and intensive symptomatic supportive care. Renal function significantly influences clinical decision-making, particularly regarding the selection of chemotherapy and antibiotic dosages, which can profoundly impact patient prognosis. Conversely, renal function recovery is a complex process influenced by factors such as disease severity, timely diagnosis, and the intensity of treatment. A crucial aspect in managing HLH-AKI is the timely diagnosis, which plays a pivotal role in reversing renal impairment and creating a therapeutic window for intervention, may have opportunity to improve patient prognosis. Understanding the clinical characteristics, underlying causes, biomarkers, immunopathogenesis, and treatment options for hemophagocytic lymphohistiocytosis associated with acute kidney injury (HLH-AKI) is crucial for improving patient prognosis.
引用
收藏
页数:14
相关论文
共 105 条
  • [1] Interferon gamma and interleukin 10 polymorphisms in Chinese children with hemophagocytic lymphohistiocytosis
    An, Qi
    Hu, Shao-Yan
    Xuan, Cheng-Min
    Jin, Ming-Wei
    Ji, Qiang
    Wang, Yi
    [J]. PEDIATRIC BLOOD & CANCER, 2017, 64 (09)
  • [2] Corticosteroids for severe sepsis: an evidence-based guide for physicians
    Annane, Djillali
    [J]. ANNALS OF INTENSIVE CARE, 2011, 1 : 1 - 7
  • [3] Prognostic factors of early death in a cohort of 162 adult haemophagocytic syndrome: impact of triggering disease and early treatment with etoposide
    Arca, Marc
    Fardet, Laurence
    Galicier, Lionel
    Riviere, Sebastien
    Marzac, Christophe
    Aumont, Cedric
    Lambotte, Olivier
    Coppo, Paul
    [J]. BRITISH JOURNAL OF HAEMATOLOGY, 2015, 168 (01) : 63 - 68
  • [4] Acute Kidney Injury in Adults With Hemophagocytic Lymphohistiocytosis
    Aulagnon, Florence
    Lapidus, Nathanael
    Canet, Emmanuel
    Galicier, Lionel
    Boutboul, David
    Peraldi, Marie-Noelle
    Reuter, Danielle
    Bernard, Remy
    Schlemmer, Benoit
    Azoulay, Elie
    Zafrani, Lara
    [J]. AMERICAN JOURNAL OF KIDNEY DISEASES, 2015, 65 (06) : 851 - 859
  • [5] Acute kidney injury induced by thrombotic microangiopathy in a patient with hemophagocytic lymphohistiocytosis
    Bae, Myoung Nam
    Kwak, Dae Hun
    Park, Se Jun
    Choi, Bum Soon
    Park, Cheol Whee
    Choi, Yeong Jin
    Lee, Jong Wook
    Yang, Chul Woo
    Kim, Yong-Soo
    Chung, Byung Ha
    [J]. BMC NEPHROLOGY, 2016, 17
  • [6] Ferritin in Kidney and Vascular Related Diseases: Novel Roles for an Old Player
    Balla, Jozsef
    Balla, Gyorgy
    Zarjou, Abolfazl
    [J]. PHARMACEUTICALS, 2019, 12 (02)
  • [7] Hemophagocytic Lymphohistiocytosis in Intensive Care Unit A 71-Case Strobe-Compliant Retrospective Study
    Barba, Thomas
    Maucort-Boulch, Delphine
    Iwaz, Jean
    Bohe, Julien
    Ninet, Jacques
    Hot, Arnaud
    Lega, Jean-Christophe
    Guerin, Claude
    Argaud, Laurent
    Broussolle, Christiane
    Jamilloux, Yvan
    Richard, Jean-Christophe
    Seve, Pascal
    [J]. MEDICINE, 2015, 94 (51)
  • [8] Confirmed efficacy of etoposide and dexamethasone in HLH treatment: long-term results of the cooperative HLH-2004 study
    Bergsten, Elisabet
    Horne, AnnaCarin
    Arico, Maurizio
    Astigarraga, Itziar
    Egeler, R. Maarten
    Filipovich, Alexandra H.
    Ishii, Eiichi
    Janka, Gritta
    Ladisch, Stephan
    Lehmberg, Kai
    McClain, Kenneth L.
    Minkov, Milen
    Montgomery, Scott
    Nanduri, Vasanta
    Rosso, Diego
    Henter, Jan-Inge
    [J]. BLOOD, 2017, 130 (25) : 2728 - 2738
  • [9] Serum soluble interleukin 2 receptor in human cancer of adults and children: a review
    Bien, E.
    Balcerska, A.
    [J]. BIOMARKERS, 2008, 13 (01) : 1 - 26
  • [10] Hemophagocytic lymphohistiocytosis in adults: collaborative analysis of 137 cases of a nationwide German registry
    Birndt, Sebastian
    Schenk, Thomas
    Heinevetter, Babett
    Brunkhorst, Frank M.
    Maschmeyer, Georg
    Rothmann, Frank
    Weber, Thomas
    Mueller, Markus
    Panse, Jens
    Penack, Olaf
    Schroers, Roland
    Braess, Jan
    Frickhofen, Norbert
    Ehl, Stephan
    Janka, Gritta
    Lehmberg, Kai
    Pletz, Mathias W.
    Hochhaus, Andreas
    Ernst, Thomas
    La Rosee, Paul
    [J]. JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY, 2020, 146 (04) : 1065 - 1077