Letter to the Editor
Acute renal failure due to rhabdomyolysis. Renal replacement therapy with intermediate cut-off membranes (EMIC2)
Fracaso renal agudo por rabdomiólisis. Tratamiento con hemodiálisis y membranas de cut-off intermedio (EMIC2)
Rafael Díaz-Tejeiro
, Dabaiba Regidor, Jorge Morales, Mayte Padrón, Laura Cueto, Miguel Angel Muñoz, Marta Torres, Francisco Javier Ahijado, Jose Eugenio García Díaz
Corresponding author
Servicio Nefrología, Hospital Virgen de la Salud, Toledo, Spain
Read
10884
Timeswas read the article
3139
Total PDF
7745
Total HTML
Share statistics
array:25 [ "pii" => "S2013251418300749" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2018.04.009" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "438" "copyright" => "Sociedad Española de Nefrología" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2018;38:664-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3633 "formatos" => array:3 [ "EPUB" => 234 "HTML" => 2655 "PDF" => 744 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S021169951730214X" "issn" => "02116995" "doi" => "10.1016/j.nefro.2017.11.001" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "438" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2018;38:664-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6391 "formatos" => array:3 [ "EPUB" => 247 "HTML" => 5064 "PDF" => 1080 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Fracaso renal agudo por rabdomiólisis. Tratamiento con hemodiálisis y membranas de cut-off intermedio (EMIC2)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "664" "paginaFinal" => "665" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute renal failure due to rhabdomyolysis. Renal replacement therapy with intermediate cut-off membranes (EMIC2)" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rafael Díaz-Tejeiro, Dabaiba Regidor, Jorge Morales, Mayte Padrón, Laura Cueto, Miguel Angel Muñoz, Marta Torres, Francisco Javier Ahijado, Jose Eugenio García Díaz" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Rafael" "apellidos" => "Díaz-Tejeiro" ] 1 => array:2 [ "nombre" => "Dabaiba" "apellidos" => "Regidor" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Morales" ] 3 => array:2 [ "nombre" => "Mayte" "apellidos" => "Padrón" ] 4 => array:2 [ "nombre" => "Laura" "apellidos" => "Cueto" ] 5 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Muñoz" ] 6 => array:2 [ "nombre" => "Marta" "apellidos" => "Torres" ] 7 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Ahijado" ] 8 => array:2 [ "nombre" => "Jose Eugenio" "apellidos" => "García Díaz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2013251418300749" "doi" => "10.1016/j.nefroe.2018.04.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418300749?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021169951730214X?idApp=UINPBA000064" "url" => "/02116995/0000003800000006/v2_201812130605/S021169951730214X/v2_201812130605/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251417302110" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2017.11.021" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "442" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2018;38:665-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3452 "formatos" => array:3 [ "EPUB" => 269 "HTML" => 2589 "PDF" => 594 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Guillian-Barre syndrome secondary to tacrolimus in a patient with corticoresistant nephrotic syndrome secondary to focal and segmental glomerulonephritis and a coexisting IgA nephropathy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "665" "paginaFinal" => "667" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome Guillain-Barré secundario a tacrolimus en paciente con síndrome nefrótico corticorresistente secundario a glomerulonefritis focal y segmentaria y nefropatía IgA" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Image 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 900 "Tamanyo" => 84724 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A brain RMN of a patient affected with GBS secondary to tacrolimus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Igor Romaniouk Jakovler, Carmen Perez Nieto, Marco Romero Antonio, Fernando Simal Blanco, Ricardo Mouzo Javier" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Igor Romaniouk" "apellidos" => "Jakovler" ] 1 => array:2 [ "nombre" => "Carmen Perez" "apellidos" => "Nieto" ] 2 => array:2 [ "nombre" => "Marco Romero" "apellidos" => "Antonio" ] 3 => array:2 [ "nombre" => "Fernando Simal" "apellidos" => "Blanco" ] 4 => array:2 [ "nombre" => "Ricardo Mouzo" "apellidos" => "Javier" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699517302199" "doi" => "10.1016/j.nefro.2017.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517302199?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251417302110?idApp=UINPBA000064" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251417302110/v1_201812140610/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2013251418300920" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2018.06.013" "estado" => "S300" "fechaPublicacion" => "2018-11-01" "aid" => "440" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2018;38:662-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1694 "formatos" => array:3 [ "EPUB" => 217 "HTML" => 940 "PDF" => 537 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Hemodialysis catheter colonised by <span class="elsevierStyleItalic">Pandoraea spotorum</span>" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "662" "paginaFinal" => "664" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colonización de catéter tunelizado para hemodiálisis por <span class="elsevierStyleItalic">Pandoraea spotorum</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Tania Monzón, Francisco Valga, Jorge Reichert, Celia López" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Tania" "apellidos" => "Monzón" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Valga" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Reichert" ] 3 => array:2 [ "nombre" => "Celia" "apellidos" => "López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699517302163" "doi" => "10.1016/j.nefro.2017.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699517302163?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418300920?idApp=UINPBA000064" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418300920/v1_201812140610/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Acute renal failure due to rhabdomyolysis. Renal replacement therapy with intermediate cut-off membranes (EMIC2)" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "664" "paginaFinal" => "665" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rafael Díaz-Tejeiro, Dabaiba Regidor, Jorge Morales, Mayte Padrón, Laura Cueto, Miguel Angel Muñoz, Marta Torres, Francisco Javier Ahijado, Jose Eugenio García Díaz" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Rafael" "apellidos" => "Díaz-Tejeiro" "email" => array:1 [ 0 => "rdtejeiro@ono.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Dabaiba" "apellidos" => "Regidor" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Morales" ] 3 => array:2 [ "nombre" => "Mayte" "apellidos" => "Padrón" ] 4 => array:2 [ "nombre" => "Laura" "apellidos" => "Cueto" ] 5 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Muñoz" ] 6 => array:2 [ "nombre" => "Marta" "apellidos" => "Torres" ] 7 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Ahijado" ] 8 => array:2 [ "nombre" => "Jose Eugenio" "apellidos" => "García Díaz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio Nefrología, Hospital Virgen de la Salud, Toledo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracaso renal agudo por rabdomiólisis. Tratamiento con hemodiálisis y membranas de cut-off intermedio (EMIC2)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rhabdomyolysis is a clinical syndrome caused by damaged skeletal muscle tissue and the release of its intracellular components, including myoglobin, lactate dehydrogenase, creatine kinase (CK), and electrolytes into the blood stream and the interstitial space. Its symptoms vary from a nearly asymptomatic condition, with myalgia and elevated CK levels, to an extremely serious condition with marked CK elevations, severe electrolyte disorders d, acute kidney failure (AKF), and disseminated intravascular coagulation (DIC).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The aetiology of the syndrome can be highly varied, with both hereditary (hereditary myopathies), and acquired factors (extreme physical activity, exposure to extreme temperatures, vascular ischaemia, trauma, drug use, toxins, sepsis, electrocution, etc.) having been reported.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most significant complication of rhabdomyolysis is AKF that occurs in up to 33% of patients present.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> The mechanism responsible for AKF lies in the release of myoglobin. Three myoglobin-mediated nephrotoxic mechanisms have been described. Renal vasoconstriction, the formation of intratubular casts, and direct damage to tubular cells.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> The best treatment for rhabdomyolysis-associated AKF is prevention. Increasing volume with crystalloid infusions to maintain good renal perfusion and high urinary flow, along with initial alkalinisation, are the bases for prevention.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> In the event that the aforementioned measures fail, it will be necessary to start renal replacement therapy, which is not indicated based on the levels of myoglobin or CK, but based on the presence of life-threatening conditions such as hyperkalaemia, hypercalcaemia, anuria or volume overload.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> Once decided to conduct renal replacement therapy, whether through intermittent haemodialysis or continuous techniques, we must consider that the toxin responsible for AKF, myoglobin, has a Pm of 17<span class="elsevierStyleHsp" style=""></span>kD, and is poorly removed by high-flux dialysers.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a> We present a case of rhabdomyolysis with AKF in a kidney transplant patient who was treated with intermittent haemodialysis with an EMIC2 dialyser (cut-off 40<span class="elsevierStyleHsp" style=""></span>kD).</p><p id="par0015" class="elsevierStylePara elsevierViewall">This is a 45-year-old patient with chronic kidney disease of unknown aetiology on peritoneal dialysis since 2009. He received the first kidney transplant from a deceased donor in 2010, with early vein thrombosis. A thrombophilia test showed a state of hypercoagulability with hyperhomocysteinaemia and elevated factor <span class="elsevierStyleSmallCaps">viii</span>. The second kidney transplant from a deceased donor was performed in 2013, with an indefinite systemic anticoagulation prescription with sintrom<span class="elsevierStyleSup">®</span>. He had an episode of late acute rejection in January 2016 which was treated with steroids. Later on, he developed nephropathy due to BK virus with stage 4 CKD (Cr 4.1<span class="elsevierStyleHsp" style=""></span>mg/dl). In October 2016, he had an episode of deep vein thrombosis in the left lower limb (LLL). Previously, anticoagulant therapy was suspended due to lower gastrointestinal bleeding secondary to a colon polyp. Treatment with sintrom was resumed and in December 2016 he was readmitted for acute LLL pain and sudden-onset oedema up to the root end of the limb, again observing deep vein thrombosis in the femoral popliteal area. At that time, the patient was not adequately anticoagulated (INR 1.4), and it was decided to treat him with sodium heparin. Poor evolution with significant oedema of the LLL, frailty, and signs of poor distal infusion, with the patient developing AKF in addition to CKD (Cr 6.6<span class="elsevierStyleHsp" style=""></span>mg/dl) with dark urine and oliguria. Ultrasound ruled out vascular involvement of the kidney graft and confirmed the existence of rhabdomyolysis (CK 44,915<span class="elsevierStyleHsp" style=""></span>mU/ml, lactate dehydrogenase 3100<span class="elsevierStyleHsp" style=""></span>U/l, GOT 392, GPT 113) and severe dyselectrolytaemia (K 6.6<span class="elsevierStyleHsp" style=""></span>mEq/l, bicarbonate 16<span class="elsevierStyleHsp" style=""></span>mEq/l). Despite the vigorous crystalloid infusion, the patient's anuria continued, with it becoming necessary to replace kidney function with emergency haemodialysis. Two 6-h dialysis sessions were completed with a 1.8<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> EMIC2 dialyser (Fresenius Polysulfone<span class="elsevierStyleSup">®</span>) and a cut-off of 40<span class="elsevierStyleHsp" style=""></span>kD with the goal of clearing myoglobin. Pre- and post-dialysis myoglobin was measured at the first session, showing a 50% decrease (pre-HD 47,110<span class="elsevierStyleHsp" style=""></span>ng/ml vs post-HD 23,500<span class="elsevierStyleHsp" style=""></span>ng/ml). After the second session, the patient resumed diuresis at a polyuria rate, recovering the kidney function he had prior to rhabdomyolysis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report this case to draw attention to the early start of replacement therapy, with the use of dialysers with an intermediate cut-off (40<span class="elsevierStyleHsp" style=""></span>kD) probably being useful in that, by increasing myoglobin clearance and decreasing serum levels, they can contribute to an earlier recovery from AKF.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz-Tejeiro R, Regidor D, Morales J, Padrón M, Cueto L, Muñoz MA, et al. Fracaso renal agudo por rabdomiólisis. Tratamiento con hemodiálisis y membranas de cut-off intermedio (EMIC2). Nefrología. 2018;38:664–665.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bench-to-bedside review: rhabdomyolysis-an overview for clinicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.L. Huerta-Alardín" 1 => "J. Varon" 2 => "P.E. Marik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc2978" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2005" "volumen" => "9" "paginaInicial" => "158" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15774072" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0055" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Vanholder" 1 => "M.S. Sever" 2 => "E. Erek" 3 => "N. Lameire" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2000" "volumen" => "11" "paginaInicial" => "1553" "paginaFinal" => "1561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10906171" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0060" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis: a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.Y. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neth J Med" "fecha" => "2009" "volumen" => "67" "paginaInicial" => "272" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19841484" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0065" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Critical care nephrology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Ronco" 1 => "R. Bellomo" 2 => "J.A. Kellum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:7 [ "edicion" => "2nd ed." "titulo" => "Myoglobin as a toxin" "fecha" => "2009" "paginaInicial" => "1103" "paginaFinal" => "1109" "editorial" => "Saunders Elsevier" "editorialLocalizacion" => "Philadelphia, PA" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0070" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plasma and urinary heme oxygenase-1 in AKI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.A. Zager" 1 => "A.C. Johnson" 2 => "K. Becker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2011121147" "Revista" => array:6 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "1048" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440905" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0075" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rhabdomyolysis: Pathogenesis, diagnosis, and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.A. Torres" 1 => "J.A. Helmstetter" 2 => "A.M. Kaye" 3 => "A.D. Kaye" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ochsner J" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "58" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25829882" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0080" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Bellomo" 1 => "J.A. Kellum" 2 => "C. Ronco" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(11)61454-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2012" "volumen" => "380" "paginaInicial" => "756" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22617274" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Petejova" 1 => "A. Martinek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc13897" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2014" "volumen" => "18" "paginaInicial" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25043142" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myoglobin removal of small-protein leakage membrane (EMIC2) in patients in the ICU: a case series" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Fabbrini" 1 => "R. Rona" 2 => "M. Migliari" 3 => "M. Viganò" 4 => "A. Pesenti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc13588" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2014" "volumen" => "18" "numero" => "Suppl. 1" "paginaInicial" => "P398" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418300749/v1_201812140610/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003800000006/v1_201812140610/S2013251418300749/v1_201812140610/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418300749?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 20 | 10 | 30 |
| 2024 October | 110 | 52 | 162 |
| 2024 September | 62 | 37 | 99 |
| 2024 August | 68 | 50 | 118 |
| 2024 July | 64 | 34 | 98 |
| 2024 June | 67 | 52 | 119 |
| 2024 May | 63 | 44 | 107 |
| 2024 April | 70 | 39 | 109 |
| 2024 March | 50 | 31 | 81 |
| 2024 February | 36 | 43 | 79 |
| 2024 January | 35 | 38 | 73 |
| 2023 December | 39 | 38 | 77 |
| 2023 November | 61 | 42 | 103 |
| 2023 October | 78 | 42 | 120 |
| 2023 September | 45 | 32 | 77 |
| 2023 August | 56 | 48 | 104 |
| 2023 July | 54 | 43 | 97 |
| 2023 June | 71 | 25 | 96 |
| 2023 May | 71 | 37 | 108 |
| 2023 April | 34 | 31 | 65 |
| 2023 March | 50 | 37 | 87 |
| 2023 February | 62 | 26 | 88 |
| 2023 January | 59 | 34 | 93 |
| 2022 December | 71 | 30 | 101 |
| 2022 November | 72 | 51 | 123 |
| 2022 October | 82 | 63 | 145 |
| 2022 September | 70 | 35 | 105 |
| 2022 August | 66 | 61 | 127 |
| 2022 July | 60 | 48 | 108 |
| 2022 June | 63 | 47 | 110 |
| 2022 May | 81 | 45 | 126 |
| 2022 April | 96 | 63 | 159 |
| 2022 March | 132 | 71 | 203 |
| 2022 February | 71 | 51 | 122 |
| 2022 January | 104 | 37 | 141 |
| 2021 December | 71 | 51 | 122 |
| 2021 November | 126 | 45 | 171 |
| 2021 October | 116 | 48 | 164 |
| 2021 September | 87 | 49 | 136 |
| 2021 August | 108 | 83 | 191 |
| 2021 July | 113 | 58 | 171 |
| 2021 June | 66 | 39 | 105 |
| 2021 May | 125 | 60 | 185 |
| 2021 April | 228 | 110 | 338 |
| 2021 March | 204 | 60 | 264 |
| 2021 February | 151 | 41 | 192 |
| 2021 January | 105 | 33 | 138 |
| 2020 December | 97 | 25 | 122 |
| 2020 November | 144 | 22 | 166 |
| 2020 October | 69 | 23 | 92 |
| 2020 September | 124 | 26 | 150 |
| 2020 August | 151 | 19 | 170 |
| 2020 July | 140 | 16 | 156 |
| 2020 June | 114 | 18 | 132 |
| 2020 May | 92 | 30 | 122 |
| 2020 April | 133 | 36 | 169 |
| 2020 March | 172 | 29 | 201 |
| 2020 February | 174 | 26 | 200 |
| 2020 January | 214 | 34 | 248 |
| 2019 December | 159 | 50 | 209 |
| 2019 November | 150 | 50 | 200 |
| 2019 October | 157 | 28 | 185 |
| 2019 September | 245 | 33 | 278 |
| 2019 August | 188 | 47 | 235 |
| 2019 July | 129 | 43 | 172 |
| 2019 June | 133 | 55 | 188 |
| 2019 May | 110 | 46 | 156 |
| 2019 April | 102 | 68 | 170 |
| 2019 March | 69 | 41 | 110 |
| 2019 February | 23 | 29 | 52 |
| 2019 January | 46 | 42 | 88 |
| 2018 December | 124 | 55 | 179 |
| 2018 November | 192 | 20 | 212 |
| 2018 October | 159 | 18 | 177 |
| 2018 September | 125 | 17 | 142 |
| 2018 August | 80 | 13 | 93 |
| 2018 July | 43 | 10 | 53 |
| 2018 June | 51 | 12 | 63 |
| 2018 May | 43 | 14 | 57 |
Show all
