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            0 => "Síndrome de ácido transretinoico"
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        "resumen" => "The all-trans retinoic acid (ATRA) is the treatment of first line of acute promyelocytic leukemia (APL). ATRA is usually well tolerated, but a few major side effects can be observed, ATRA syndrome (RAS) being the most important of them, potentially fatal. The manifestations of this Syndrome are fever, weight gain, pulmonary infiltrates, pleural or pericardial effusions, hypotension, liver dysfunction and renal failure. Material and methods: We studied to the 29 patients diagnosed in (January of 2002 - December of 2004) of acute promyelocytic leukemia (APL), which were treated with ATRA, all received the 45 dose of mg/m2/d . The diagnosis of the leukemia was made by citomorphologist analysis. The criterion of renal insufficiency, it was an increase of the creatinina superior to 20% of the basal level. The definition of the transretinoico acid Syndrome was based on the clinical criteria of Frankel. Results: Fourteen patients presented the Transretinoico Syndrome (48.3%), 11 of which (37.9%) died. The fundamental differences between the patients with or without ATRA were: fever (14 vs. 9, p=0,017), gain of weight (14 vs 0, p=0,000), pleural effusion (14 vs 2, p=0.000), pulmonary infiltrates (13 vs 1, p=0,000), cardiac failure (12 versus 2, p=0,000), respiratory distress (12 versus 4, p=0,003), presence of renal failure (10 vs 4, p=0,02), necessity of substitute renal treatment (6 vs 0, p=0,006) and arterial hypotension (12 vs. 3, p=0,001). The acute renal failure appeared in 10 of the 14 patients with SAR (71.4%), to 12±5 (1-25) days of the beginning of the treatment and their duration it was of 14±5 (1-46) days. Six (60%) needed substitute renal treatment and 5 (50%) died. Of the patients who survived, only a patient continues in dialysis. In both patient in that renal biopsy was made, the study showed signs of cortical necrosis. Conclusions: The appearance of acute renal failure in the course of the SAR is frequent, being observed deterioration of the renal function that needs substitute renal treatment in more than half the cases. The association of RAS with renal failure entails the high mortality (50%). The diagnosis and the precocious restoration of suitable the preventive measures and therapeutic are very important to avoid in possible the this serious complication of the treatment with ATRA. "
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        "resumen" => "El ácido transretinoico es el tratamiento de primera línea de la Leucemia Promielocítica Aguda. Habitualmente es bien tolerado, pero puede tener efectos secundarios, de los cuales el más grave es el Síndrome de Ácido Transretinoico, potencialmente fatal. Las manifestaciones de este Síndrome son fiebre, ganancia de peso, infiltrados pulmonares, derrame pleural o pericárdico, hipotensión, insuficiencia hepática e insuficiencia renal. Material y métodos. Se estudiaron 29 pacientes diagnosticados en los últimos 3 años (enero de 2002-diciembre de 2004) de Leucemia Promielocítica Aguda que fueron tratados con ácido transretinoico a dosis de 45 mg/m2/día. El diagnóstico de la leucemia se realizó por análisis citomorfológico. La insuficiencia renal aguda (IRA) se definió como un incremento de la creatinina superior al 20% del nivel basal y el Síndrome de Ácido Transretinoico (SAR) por los criterios de Frankel. Resultados. Catorce pacientes presentaron el Síndrome Transretinoico (48,3%), 11 de los cuales fallecieron (37,9%). Las diferencias fundamentales entre los pacientes con o sin ATRA fueron: fiebre (14 vs. 9, p=0,017), ganancia de peso (14 vs. 0, p=0,000), derrame pleural (14 vs. 2, p=0.000), presencia de infiltrados pulmonares (13 vs. 1, p=0,000), insuficiencia cardiaca (12 vs, 2, p=0,000), distress respiratorio (12 vs. 4, p=0,003), presencia de IRA (10 vs. 4, p=0,02), necesidad de tratamiento renal sustitutivo (6 vs. 0, p=0,006) e hipotensión arterial (12 vs. 3, p=0,001). La insuficiencia renal se produjo en 10 de los 14 pacientes con SAR (71,4%), a los 12±5 (1-25) días del comienzo del tratamiento y su duración media fue de 14±5 (1-46) días. Seis (60%) necesitaron tratamiento renal sustitutivo y 5 (50%) fallecieron. De los pacientes que sobrevivieron, sólo un paciente continúa en diálisis. En los dos pacientes en los que se realizó biopsia renal, el estudio histológico mostró signos de necrosis cortical. Conclusiones. La aparición de insuficiencia renal en el transcurso del SAR es frecuente, precisando tratamiento renal sustitutivo en más de la mitad de los casos. La asociación de SAR con IRA conlleva una alta mortalidad. El diagnóstico y la instauración precoz de las medidas preventivas y terapéuticas adecuadas son muy importantes para evitar en lo posible esta grave complicación del tratamiento con ATRA. "
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