Letter to the Editor
Not all cytokin storms are due to COVID-19: Hemophagotic syndrome with renal involvement secondary to extranasal lymphoma and Epstein-Barr virus. A case report during the pandemic
No todas las tormentas de citoquinas son por COVID-19: Síndrome hemofagocítico con afectación renal, secundario a linfoma extranasal y virus de Epstein-Barr. A propósito de un caso durante la pandemia
Adonay Santana Quintana
, Francisco Valga, Nicanor Vega Díaz, Juan Manuel Fernández, Juan Carlos Quevedo Reina, Marian Rincón Tirado, Sara Aladro Escribano, José Carlos Rodríguez Pérez
Corresponding author
Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Canarias, Spain
Read
5878
Timeswas read the article
1768
Total PDF
4110
Total HTML
Share statistics
array:24 [ "pii" => "S201325142100064X" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2021.07.004" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "765" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia (English Version). 2021;41:347-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0211699520301223" "issn" => "02116995" "doi" => "10.1016/j.nefro.2020.07.004" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "765" "copyright" => "Sociedad Española de Nefrología" "documento" => "simple-article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Nefrologia. 2021;41:347-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "No todas las tormentas de citoquinas son por COVID-19: Síndrome hemofagocítico con afectación renal, secundario a linfoma extranasal y virus de Epstein-Barr. A propósito de un caso durante la pandemia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "349" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Not all cytokin storms are due to COVID-19: Hemophagotic syndrome with renal involvement secondary to extranasal lymphoma and Epstein-Barr virus. A case report during the pandemic" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Adonay Santana Quintana, Francisco Valga, Nicanor Vega Díaz, Juan Manuel Fernández, Juan Carlos Quevedo Reina, Marian Rincón Tirado, Sara Aladro Escribano, José Carlos Rodríguez Pérez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Adonay" "apellidos" => "Santana Quintana" ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Valga" ] 2 => array:2 [ "nombre" => "Nicanor" "apellidos" => "Vega Díaz" ] 3 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Fernández" ] 4 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Quevedo Reina" ] 5 => array:2 [ "nombre" => "Marian" "apellidos" => "Rincón Tirado" ] 6 => array:2 [ "nombre" => "Sara" "apellidos" => "Aladro Escribano" ] 7 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S201325142100064X" "doi" => "10.1016/j.nefroe.2021.07.004" "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/S201325142100064X?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699520301223?idApp=UINPBA000064" "url" => "/02116995/0000004100000003/v1_202105080820/S0211699520301223/v1_202105080820/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2013251421000638" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2021.07.003" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "764" "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). 2021;41:349-51" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pericarditis secondary to COVID-19 infection in a kidney transplant recipient" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "349" "paginaFinal" => "351" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pericarditis secundaria a infección por COVID-19 en un paciente trasplantado renal" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1253 "Ancho" => 1305 "Tamanyo" => 578417 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Electrocardiogram at the time of onset of chest pain, showing generalised PR segment depression and ST segment elevation in V3–V5. B) Electrocardiogram at discharge, with resolution of the previous alterations.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Justo Sandino Pérez, Lucia Aubert Girbal, Fernando Caravaca-Fontán, Natalia Polanco, Ángel Sevillano Prieto, Amado Andrés" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Justo" "apellidos" => "Sandino Pérez" ] 1 => array:2 [ "nombre" => "Lucia" "apellidos" => "Aubert Girbal" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Caravaca-Fontán" ] 3 => array:2 [ "nombre" => "Natalia" "apellidos" => "Polanco" ] 4 => array:2 [ "nombre" => "Ángel" "apellidos" => "Sevillano Prieto" ] 5 => array:2 [ "nombre" => "Amado" "apellidos" => "Andrés" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699520301211" "doi" => "10.1016/j.nefro.2020.07.003" "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/S0211699520301211?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000638?idApp=UINPBA000064" "url" => "/20132514/0000004100000003/v1_202109180529/S2013251421000638/v1_202109180529/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2013251421000699" "issn" => "20132514" "doi" => "10.1016/j.nefroe.2021.08.002" "estado" => "S300" "fechaPublicacion" => "2021-05-01" "aid" => "795" "copyright" => "Sociedad Española de Nefrología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2021;41:337-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Risk factors associated with valvular calcification in patients with chronic kidney disease. Analysis of NEFRONA study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "346" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores de riesgo asociados a la calcificación valvular en pacientes con enfermedad renal crónica. Análisis del Estudio Nefrona" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1466 "Ancho" => 2500 "Tamanyo" => 99636 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Result of the multivariate analysis of aortic calcification at 24 months.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lidia Martínez Fernández, J. Emilio Sánchez-Alvarez, César Morís de la Tassa, José Joaquín Bande Fernández, Virtudes María, Elvira Fernández, Jose M. Valdivielso, Angels Betriu" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Lidia" "apellidos" => "Martínez Fernández" ] 1 => array:2 [ "nombre" => "J. Emilio" "apellidos" => "Sánchez-Alvarez" ] 2 => array:2 [ "nombre" => "César" "apellidos" => "Morís de la Tassa" ] 3 => array:2 [ "nombre" => "José Joaquín" "apellidos" => "Bande Fernández" ] 4 => array:2 [ "nombre" => "Virtudes" "apellidos" => "María" ] 5 => array:2 [ "nombre" => "Elvira" "apellidos" => "Fernández" ] 6 => array:2 [ "nombre" => "Jose M." "apellidos" => "Valdivielso" ] 7 => array:2 [ "nombre" => "Angels" "apellidos" => "Betriu" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0211699520301752" "doi" => "10.1016/j.nefro.2020.08.012" "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/S0211699520301752?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251421000699?idApp=UINPBA000064" "url" => "/20132514/0000004100000003/v1_202109180529/S2013251421000699/v1_202109180529/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Not all cytokin storms are due to COVID-19: Hemophagotic syndrome with renal involvement secondary to extranasal lymphoma and Epstein-Barr virus. A case report during the pandemic" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "349" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adonay Santana Quintana, Francisco Valga, Nicanor Vega Díaz, Juan Manuel Fernández, Juan Carlos Quevedo Reina, Marian Rincón Tirado, Sara Aladro Escribano, José Carlos Rodríguez Pérez" "autores" => array:8 [ 0 => array:4 [ "nombre" => "Adonay" "apellidos" => "Santana Quintana" "email" => array:1 [ 0 => "adocsq@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Valga" ] 2 => array:2 [ "nombre" => "Nicanor" "apellidos" => "Vega Díaz" ] 3 => array:2 [ "nombre" => "Juan Manuel" "apellidos" => "Fernández" ] 4 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Quevedo Reina" ] 5 => array:2 [ "nombre" => "Marian" "apellidos" => "Rincón Tirado" ] 6 => array:2 [ "nombre" => "Sara" "apellidos" => "Aladro Escribano" ] 7 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas, Canarias, 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" => "No todas las tormentas de citoquinas son por COVID-19: Síndrome hemofagocítico con afectación renal, secundario a linfoma extranasal y virus de Epstein-Barr. A propósito de un caso durante la pandemia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Haemophagocytic syndrome (HS) or haemophagocytic lymphohistiocytosis is an uncommon disease characterised by a hyperactive and inefficient immune response to antigen presentation. Its origin is the inherent (primary) or acquired (secondary) incapacity of cytotoxic T-lymphocytes and natural killer (NK) cells to prduce cell lysis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> This immune dysregulation gives rise to a marked proliferation of histiocytes and lymphocytes that invade various organs (spleen, liver, lymph nodes, among others), leading to overproduction of cytokines and consequently systemic inflammatory response syndrome (SIRS), multiorgan dysfunction, and even death.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It has been suggested that COVID-19 possesses HS-like pathogenic mechanisms,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> so the latter is included in its differential diagnosis. Acute kidney failure is a common manifestation associated with multi-system involvement of this syndrome, and is associated with a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Given the coincidence in the time of the diagnosis of this case and the peak of the SARS-CoV-2 outbreak in our community, we believe its discussion is relevant.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 51-year-old male with normal renal function and a history of hypertension attended the emergency room due to intermittent fever and weight loss of three weeks’ duration associated with jaundice and choluria in the days prior to hospital admission. In the physical examination he presented cutaneous and conjunctival jaundice. The blood work showed a serum creatinine of 3.4 mg/dl (estimated glomerular filtration rate (eGFR) by CKD-EPI 19.8 ml/min/1.73 m<span class="elsevierStyleSup">2</span>), plasma sodium 126 mEq/l, plasma osmolality 271 mOsm/kg, pancytopenia (leukocytes 1,000 U/l, Hb 9.62 g/dl and platelets 50,900 U/l), triglycerides 689 mg/dl, ferritin 33,511 ng/mL, AST 218 U/l, ALT 113 U/l, LDH 1.751 U/l, GGT 223 U/l, ALP 962 U/l, total bilirubin 9.29 mg/d. (direct bilirubin 9.21 mg/dl) and fibrinogen 139 mg/dl. The urinalysis found microhaematuria with 25 red blood cells (5–10 per field), fractional excretion of sodium 2.7% and proteinuria 1.48 g/24 h. The SARS-CoV-2 PCR study was negative and serology for bacteria, autoimmunity and a blood smear were unremarkable. Nevertheless, haemophagocytes were found in bone marrow (BM) aspirate. In addition, BM biopsy revealed signs compatible with T-cell non-Hodgkin lymphoma and the viral load in blood of the Epstein-Barr virus was 644,558 copies, with a BM culture also positive (454,386 copies). The CT of abdomen showed hepatosplenomegaly and mediastinal, retroperitoneal, iliac and inguinal adenopathies. According to the HScore,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the probability of HS was greater than 99%. A lymph node biopsy was performed that revealed extranasal NK/T lymphoma. Specific treatment was started with fluid therapy adjustment, two doses of rituximab, three doses of gammaglobulin and two doses of etoposide and, from a nephrology point of view, the patient presented gradual improvement of kidney function, reaching a serum creatinine level of 1 mg/dl (eGFR CKD-EPI 86.8 ml/min/1.73 m<span class="elsevierStyleSup">2</span>) and proteinuria of 1.1 g/24 h 20 days after our first assessment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Haemophagocytic syndrome is characterised by an aggressive but ineffective response to a noxious substance. Its importance during the current pandemic arises from that fact that it has high mortality and requires high diagnostic suspicion, given its similarity with severe SARS-CoV-2 infection and Systemic Inflammatory Response Syndrome (SIRS) secondary to sepsis, trauma or autoimmune/autoinflammatory processes.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,9</span></a> Renal involvement in this syndrome may result in acute kidney failure (the most common form of presentation), glomerulopathy,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> or thrombotic microangiopathy (TMA).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The presence of acute kidney failure has an incidence that varies from 8% to 62%, according to different series.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Aulagnon et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> found that up to 78% of cases presented a multifactorial cause, the most common were acute tubular necrosis, hypoperfusion, use of nephrotoxic agents and tumour lysis syndrome. A 86% presented acute kidney failure ≥2, and 59% required renal replacement therapy. There are cases reported in kidney transplant recipients, generally triggering by viral infection, as in the case being presented.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> In our patient, the acute kidney failure was likely secondary to acute tubular necrosis in a context of renal hypoperfusion and hyperbilirubinaemia with a subsequent gradual recovery of renal function. Proteinuria may be present, even in nephrotic ranges, as is described by Thaunat et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>; in this collection of cases the glomerulopathies involved were: minimal changes, focal segmental glomerulosclerosis and TMA. In our case, no renal biopsy was performed due to the high risk of bleeding, a common problem in this type of pathologies.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To conclude, the Hemophagotic Syndrome is a rare entity that require a high degree of clinical suspicion for its diagnosis. Moreover, since it shares clinical characteristics with SARS-CoV-2 infection, we believe it is necessary to consider it within the differential diagnosis (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,11,14</span></a> As nephrologists, we need to be aware that renal involvement is common and it is associated with a poor prognosis. The possibility of renal biopsy may be considered after careful assessment of the risk-benefit ratio.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Funding</p><p id="par0030" class="elsevierStylePara elsevierViewall">The authors did not receive financial support for the research, auditing and/or publication of this article.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Conflicts of interest</p><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</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: Santana Quintana A, Valga F, Vega Díaz N, Fernández JM, Quevedo Reina JC, Rincón Tirado M, et al. No todas las tormentas de citoquinas son por COVID-19: Síndrome hemofagocítico con afectación renal, secundario a linfoma extranasal y virus de Epstein-Barr. A propósito de un caso durante la pandemia. Nefrologia. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.nefro.2020.07.004">https://doi.org/10.1016/j.nefro.2020.07.004</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BMT: bone marrow transplant. GCSF: granulocyte colony-stimulating factor.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">HS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COVID-19 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Common \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thrombocytopaenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">+ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haptoglobin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal or reduced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LDH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Elevated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ferritin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertransaminasaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schistocytes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D-dimer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibrinogen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Coagulation test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abnormal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antiphospholipid antibodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rare \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rare \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Main cytokines involved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Interferon-gamma TNF-alpha, IL-1beta, IL-6, IL-8, IL-10, IL-18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IL-6, IL-1beta, IL-2, IL-17, IL-8, TNF-alpha, IL-7, GCSF, interferon-gamma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Histology</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Histiocytes with haemophagocytosis</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Endothelial damage \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microthrombi \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Haemophagocytosis (described) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complement alteration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sometimes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Systemic involvement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead rowgroup " rowspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapy</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etoposide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anticoagulant (heparin)? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antivirals? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunoglobulin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Steroids? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyclosporin A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tocilizumab? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anti-TNF antibodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Eculizumab? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2697170.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison between haemophagocytic syndrome (HS) and COVID-19 (adapted from Valga et al.).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemophagocytic lymphohistiocytosis: advances in pathophysiology, diagnosis, and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Chandrakasan" 1 => "A.H. Filipovich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2013.06.053" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2013" "volumen" => "163" "paginaInicial" => "1253" "paginaFinal" => "1259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23953723" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemophagocytic syndromes—an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.E. Janka" 1 => "K. Lehmberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.blre.2014.03.002" "Revista" => array:6 [ "tituloSerie" => "Blood Rev" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "135" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24792320" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemophagocytic lymphohistiocytosis (HLH): a heterogeneous spectrum of cytokine-driven immune disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Brisse" 1 => "C.H. Wouters" 2 => "P. Matthys" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cytogfr.2014.10.001" "Revista" => array:6 [ "tituloSerie" => "Cytokine Growth Factor Rev" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "263" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25466631" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How I treat hemophagocytic lymphohistiocytosis in the adult patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.M. Schram" 1 => "N. Berliner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2015-01-551622" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2015" "volumen" => "125" "paginaInicial" => "2908" "paginaFinal" => "2914" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25758828" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hemophagocytic lymphohistiocytosis: an update for nephrologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.J. Filippone" 1 => "J.L. Farber" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11255-016-1294-z" "Revista" => array:6 [ "tituloSerie" => "Int Urol Nephrol" "fecha" => "2016" "volumen" => "48" "paginaInicial" => "1291" "paginaFinal" => "1304" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27098410" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Mehta" 1 => "D.F. McAuley" 2 => "M. Brown" 3 => "E. Sanchez" 4 => "R.S. Tattersall" 5 => "J.J. Manson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(20)30628-0" "Revista" => array:5 [ "tituloSerie" => "Lancet" "fecha" => "2020" "volumen" => "395" "paginaInicial" => "1033" "paginaFinal" => "1034" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute kidney injury in adults with hemophagocytic lymphohistiocytosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Aulagnon" 1 => "N. Lapidus" 2 => "E. Canet" 3 => "L. Galicier" 4 => "D. Boutboul" 5 => "M.N. Peraldi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2014.10.012" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2015" "volumen" => "65" "paginaInicial" => "851" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25480521" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of the HScore, a score for the diagnosis of reactive hemophagocytic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Fardet" 1 => "L. Galicier" 2 => "O. Lambotte" 3 => "C. Marzac" 4 => "C. Aumont" 5 => "D. Chahwan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/art.38690" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheumatol" "fecha" => "2014" "volumen" => "66" "paginaInicial" => "2613" "paginaFinal" => "2620" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24782338" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypercytokinemia in hemophagocytic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F. Fujiwara" 1 => "S. Hibi" 2 => "S. Imashuku" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00043426-199302000-00012" "Revista" => array:7 [ "tituloSerie" => "Am J Pediatr Hematol Oncol" "fecha" => "1993" "volumen" => "15" "paginaInicial" => "92" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8447564" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1201971214014994" "estado" => "S300" "issn" => "12019712" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nephrotic syndrome associated with hemophagocytic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Thaunat" 1 => "M. Delahousse" 2 => "F. Fakhouri" 3 => "F. Martinez" 4 => "J.L. Stephan" 5 => "L.H. Noël" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/sj.ki.5000352" "Revista" => array:5 [ "tituloSerie" => "Kidney Int" "fecha" => "2006" "volumen" => "69" "paginaInicial" => "1892" "paginaFinal" => "1898" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An update on renal involvement in hemophagocytic syndrome (macrophage activation syndrome)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Esmaili" 1 => "E. Mostafidi" 2 => "B. Mehramuz" 3 => "M. Ardalan" 4 => "M. Mohajel-Shoja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15171/jnp.2016.02" "Revista" => array:6 [ "tituloSerie" => "J Nephropathol" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "8" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27047804" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome hemofagocítico reactivo a infección por CMV en paciente trasplantado renal [Cytomegalovirus-associated haemophagocytic syndrome in a kidney transplant patient]" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Bea Granell" 1 => "I. Beneyto Castello" 2 => "D. Ramos Escorihuela" 3 => "J. Sánchez Plumed" 4 => "P. Sánchez Pérez" 5 => "J. Hernández-Jaras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2010.Nov.10639" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "236" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21461026" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reactive haemophagocytic syndrome associated with parvovirus B19 in a kidney-pancreas transplant patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Tavera" 1 => "J. Petroni" 2 => "L. León" 3 => "E. Minue" 4 => "D. Casadei" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3265/Nefrologia.pre2011.Oct.11179" "Revista" => array:6 [ "tituloSerie" => "Nefrologia" "fecha" => "2012" "volumen" => "32" "paginaInicial" => "125" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22294016" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Targeting complement in severe Coronavirus disease 2019 to address microthrombosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Valga" 1 => "N. Vega-Díaz" 2 => "M. Macia" 3 => "T. Monzón" 4 => "J.C. Rodriguez-Perez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ckj/sfaa095" "Revista" => array:2 [ "tituloSerie" => "Clin Kidney J" "fecha" => "2020" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000004100000003/v1_202109180529/S201325142100064X/v1_202109180529/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/20132514/0000004100000003/v1_202109180529/S201325142100064X/v1_202109180529/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S201325142100064X?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 46 | 22 | 68 |
| 2024 September | 78 | 35 | 113 |
| 2024 August | 107 | 67 | 174 |
| 2024 July | 87 | 28 | 115 |
| 2024 June | 89 | 42 | 131 |
| 2024 May | 89 | 40 | 129 |
| 2024 April | 79 | 36 | 115 |
| 2024 March | 100 | 34 | 134 |
| 2024 February | 69 | 32 | 101 |
| 2024 January | 44 | 33 | 77 |
| 2023 December | 36 | 30 | 66 |
| 2023 November | 69 | 44 | 113 |
| 2023 October | 102 | 78 | 180 |
| 2023 September | 287 | 45 | 332 |
| 2023 August | 361 | 35 | 396 |
| 2023 July | 410 | 41 | 451 |
| 2023 June | 224 | 31 | 255 |
| 2023 May | 179 | 32 | 211 |
| 2023 April | 109 | 38 | 147 |
| 2023 March | 82 | 30 | 112 |
| 2023 February | 53 | 30 | 83 |
| 2023 January | 68 | 36 | 104 |
| 2022 December | 78 | 45 | 123 |
| 2022 November | 80 | 54 | 134 |
| 2022 October | 92 | 74 | 166 |
| 2022 September | 70 | 50 | 120 |
| 2022 August | 55 | 43 | 98 |
| 2022 July | 77 | 68 | 145 |
| 2022 June | 86 | 53 | 139 |
| 2022 May | 95 | 31 | 126 |
| 2022 April | 90 | 69 | 159 |
| 2022 March | 100 | 75 | 175 |
| 2022 February | 102 | 53 | 155 |
| 2022 January | 105 | 72 | 177 |
| 2021 December | 97 | 51 | 148 |
| 2021 November | 71 | 42 | 113 |
| 2021 October | 80 | 82 | 162 |
| 2021 September | 64 | 67 | 131 |
Show all
