array:24 [
  "pii" => "S0211699515001538"
  "issn" => "02116995"
  "doi" => "10.1016/j.nefro.2015.07.007"
  "estado" => "S300"
  "fechaPublicacion" => "2016-01-01"
  "aid" => "101"
  "copyright" => "Sociedad Española de Nefrología"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia. 2016;36:72-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5671
    "formatos" => array:3 [
      "EPUB" => 305
      "HTML" => 4601
      "PDF" => 765
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0211699515001381"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2015.08.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "86"
    "copyright" => "Sociedad Española de Nefrología"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2016;36:75-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5482
      "formatos" => array:3 [
        "EPUB" => 387
        "HTML" => 4255
        "PDF" => 840
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Methylmalonic acidemia with emergency hypertension"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "75"
          "paginaFinal" => "76"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidemia metilmal&#243;nica con hipertensi&#243;n de emergencia"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Bahareh Yaghmaei, Parastoo Rostami, Farnaz Najmi Varzaneh, Behdad Gharib, Behnaz Bazargani, Nima Rezaei"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Bahareh"
              "apellidos" => "Yaghmaei"
            ]
            1 => array:2 [
              "nombre" => "Parastoo"
              "apellidos" => "Rostami"
            ]
            2 => array:2 [
              "nombre" => "Farnaz Najmi"
              "apellidos" => "Varzaneh"
            ]
            3 => array:2 [
              "nombre" => "Behdad"
              "apellidos" => "Gharib"
            ]
            4 => array:2 [
              "nombre" => "Behnaz"
              "apellidos" => "Bazargani"
            ]
            5 => array:2 [
              "nombre" => "Nima"
              "apellidos" => "Rezaei"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001381?idApp=UINPBA000064"
    "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001381/v1_201602110042/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0211699515001411"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2015.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "89"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Nefrologia. 2016;36:69-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 10984
      "formatos" => array:3 [
        "EPUB" => 346
        "HTML" => 9417
        "PDF" => 1221
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director&#58; Comentarios breves sobre casos cl&#237;nicos</span>"
      "titulo" => "Nefritis intersticial aguda por ibuprofeno en poblaci&#243;n pedi&#225;trica"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "69"
          "paginaFinal" => "71"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Ibuprofen-induced acute interstitial nephritis in the paediatric population"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1974
              "Ancho" => 1658
              "Tamanyo" => 175863
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n temporal de las cifras de creatinina y urea&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Belen Mart&#237;nez L&#243;pez, Olalla &#193;lvarez Blanco, Augusto Luque de Pablos, Mar&#237;a Dolores Morales San-Jos&#233;, Ana Rodr&#237;guez Sanchez de la Blanca"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ana Belen"
              "apellidos" => "Mart&#237;nez L&#243;pez"
            ]
            1 => array:2 [
              "nombre" => "Olalla"
              "apellidos" => "&#193;lvarez Blanco"
            ]
            2 => array:2 [
              "nombre" => "Augusto"
              "apellidos" => "Luque de Pablos"
            ]
            3 => array:2 [
              "nombre" => "Mar&#237;a Dolores"
              "apellidos" => "Morales San-Jos&#233;"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Rodr&#237;guez Sanchez de la Blanca"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251416000250"
        "doi" => "10.1016/j.nefroe.2016.02.004"
        "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/S2013251416000250?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001411?idApp=UINPBA000064"
    "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001411/v1_201602110042/es/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Eculizumab for the treatment of an atypical hemolytic uremic syndrome with mutations in complement factor I and C3"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "72"
        "paginaFinal" => "75"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Emanuel Ferreira, Nuno Oliveira, Maria Marques, Lu&#237;s Francisco, Ana Santos, Armando Carreira, M&#225;rio Campos"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Emanuel"
            "apellidos" => "Ferreira"
            "email" => array:1 [
              0 => "emanuelfeferreira&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Oliveira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Marques"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Lu&#237;s"
            "apellidos" => "Francisco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Santos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Armando"
            "apellidos" => "Carreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#225;rio"
            "apellidos" => "Campos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Hematolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospitais da Universidade de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>&#58; Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#46;&#44; Rua do Buxo&#44; lote 17&#44; 3040-792 Coimbra&#44; Portugal&#46; Tel&#46;&#58; &#43;351 916699039&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Eculizumab para el tratamiento de un s&#237;ndrome ur&#233;mico hemol&#237;tico at&#237;pico con mutaciones en los factores I y C3 del sistema del complemento"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3462
            "Ancho" => 2454
            "Tamanyo" => 392693
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course&#58; laboratory data and treatment&#46; Corticosteroid therapy was started with intravenous administration of methylprednisolone &#40;1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 3 days&#41; followed by oral prednisolone and an initial dosage of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; This dosage was maintained until the 53rd day after admission&#44; with posterior tapering&#46; Rituximab &#40;arrows&#41; was administered at a dose of 600<span class="elsevierStyleHsp" style=""></span>mg &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m2&#41; on the 27th&#44; 34th&#44; 41st and 48th days after admission&#46; Cyclophosphamide &#40;arrowhead&#41; was administered in a single dose of 1000<span class="elsevierStyleHsp" style=""></span>mg on the 61st day after admission &#40;2nd day after readmission&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg for a week for 4 weeks&#44; started on the 158th day after admission&#44; followed by a dosage of 1200<span class="elsevierStyleHsp" style=""></span>mg 1 week later an then a maintenance dose of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks&#46; This dosage is still being continued&#46; We performed a total of 79 plasma exchange sessions&#46; The last three laboratorial test results were done on the 270th&#44; 340th and 466th days following first admission&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atypical hemolytic-uremic syndrome &#40;aHUS&#41; is a rare&#44; life-threatening complement-mediated thrombotic microangiopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Approximately half of cases have mutations in complement proteins but only 12&#37; have 2 or more mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Eculizumab is nowadays considered first-line therapy for aHUS&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old female with unremarkable past medical history presented with a 3-day history of decreased urine output&#46; Physical examination showed hypertension &#40;160&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and lower limbs edema&#46; Investigations revealed an acute thrombotic microangiopathy &#40;ATM&#41;&#44; hematuria and nephrotic proteinuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Daily plasmapheresis &#40;PMP&#41; was started immediately&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Investigations for secondary causes of ATM revealed a low ADAMTS 13 activity&#44; decreased complement C4&#44; C3&#44; C1q and C2 levels and positive serum cryoglobulins &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Considering the hypothesis of an autoimmune disorder&#44; we started 3 daily pulses of 1000<span class="elsevierStyleHsp" style=""></span>mg methylprednisolone followed by oral prednisolone&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">PMP was stopped on the eighteenth day of admission &#40;D18&#41; due to normal platelet count during 3 consecutive days &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On the D19 a renal biopsy was made&#46; It showed a &#8220;thrombotic microangiopathy with acute tubular necrosis&#8221; and &#8220;deposition of IgM&#44; C3 and C1q in the capillary wall&#8221;&#46; Due to increased hemolytic activity&#44; PMP was resumed on the D21&#46; On the D27&#44; rituximab was started to enhance immunosuppression&#46; PMP was stopped on the D35 based on the absence of schistocytosis&#44; hemoglobin stability and lactate dehydrogenase &#40;LDH&#41; normalization&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the D50&#44; LDH was high but hemoglobin and platelet count were stable&#46; A state of compensated hemolysis was assumed and the patient was discharged home&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ten days later she was readmitted due to increased hemolytic activity &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; PMP was resumed and 1000<span class="elsevierStyleHsp" style=""></span>mg cyclophosphamide was given&#46; At that time ADAMTS13 and complement C4 levels were normal but complement C3 levels remained low&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A genetic screening for mutations in complement regulatory proteins was made&#46; Two mutations were found in factor I &#40;C&#46; 452 A&#62;G&#44; pASN 151 Ser&#41; and C3 &#40;C193 A<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>C&#44; pLys 65 Gin&#41; proteins&#46; The process of eculizumab acquisition was lengthy&#44; wherefore this therapy was started only on the 98th day after readmission&#46; At that moment we were performing one PMP session&#47;week&#44; LDH remained high &#40;859<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41; and moderate renal dysfunction &#40;creatinine 2&#46;08<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and urea 60<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and nephrotic proteinuria persisted &#40;5&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg per week for 4 weeks followed by subsequent doses of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks since the 5th week&#46; Complete hematologic remission was attained 2 days after eculizumab initiation&#46; The patient was discharged home on the 105th day after readmission&#46; Four weeks later&#44; proteinuria was only 0&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently&#44; 10 months after first infusion&#44; the patient remains under biweekly administration of eculizumab&#46; Hematologic remission persists and there is a significant recover of renal function &#40;urea 43<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; creatinine 1&#46;27<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Complement factor I &#40;CFI&#41; and C3 mutations account for 10&#37; and 4&#37; of the overall aHUS-associated mutations&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> C3 mutations are among the ones with the poorest prognosis&#58; 75&#37; risk of death or end stage renal failure &#40;ESRF&#41; at 3&#8211;5 years follow up and 50&#37; risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> CFI mutations have a 50&#8211;60&#37; risk of death and ESRF at 3&#8211;5 years follow up and 10&#8211;30&#37; risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Both mutations present in our patient were previously reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> The p&#46;Asn151Ser mutation causes a quantitative deficiency of factor I<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and the p&#46;Lys65Gin mutation weakens the affinity of C3b to complement factor H&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the growing importance of eculizumab&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a> PMP remains the mainstay of treatment while waiting for the immunoglobulin&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Nonetheless&#44; its benefit depends on the underlying genetic defect &#8211; only 25&#37; and 57&#37; of those with CFI and C3 mutations&#44; respectively&#44; achieve remission&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In our patient&#44; PMP was critical to prevent further progression of renal failure and the development of other systemic involvement&#46; However&#44; as described by Loirat&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> it was unable to achieve complete and sustained remission&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In our case&#44; the confounding presence of low ADAMTS13&#44; C4&#44; C2 and C1q levels&#44; the presence of cryoglobulins and the existence of immune deposits in the glomerular capillary wall led to the misdiagnosis of a thrombotic thrombocytopenic purpura secondary to an autoimmune disease&#46; It explains the preference for glucocorticoids&#44; rituximab and cyclophosphamide in relation to eculizumab&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Eculizumab is nowadays considered first-line therapy for aHUS&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It is a humanized monoclonal immunoglobulin IgG that targets C5 and blocks the uncontrolled generation of the cytotoxic membrane attack complex&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> When we started Eculizumab&#44; our patient was still PMP dependent despite the 79 PMP sessions&#46; Contrariwise&#44; complete hematologic remission was attained two days after first infusion and a remarkable recover of renal function and reduction of proteinuria was evident&#46; These findings reinforce the benefits of eculizumab in aHUS&#44; even in cases of severe renal involvement&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; our case highlights the diagnostic challenge of aHUS and emphasizes the notion that isolated PMP is no longer the best therapeutic option in aHUS&#44; in which cases a prompt switch to eculizumab is mandatory&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3462
            "Ancho" => 2454
            "Tamanyo" => 392693
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course&#58; laboratory data and treatment&#46; Corticosteroid therapy was started with intravenous administration of methylprednisolone &#40;1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 3 days&#41; followed by oral prednisolone and an initial dosage of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; This dosage was maintained until the 53rd day after admission&#44; with posterior tapering&#46; Rituximab &#40;arrows&#41; was administered at a dose of 600<span class="elsevierStyleHsp" style=""></span>mg &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m2&#41; on the 27th&#44; 34th&#44; 41st and 48th days after admission&#46; Cyclophosphamide &#40;arrowhead&#41; was administered in a single dose of 1000<span class="elsevierStyleHsp" style=""></span>mg on the 61st day after admission &#40;2nd day after readmission&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg for a week for 4 weeks&#44; started on the 158th day after admission&#44; followed by a dosage of 1200<span class="elsevierStyleHsp" style=""></span>mg 1 week later an then a maintenance dose of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks&#46; This dosage is still being continued&#46; We performed a total of 79 plasma exchange sessions&#46; The last three laboratorial test results were done on the 270th&#44; 340th and 466th days following first admission&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:2 [
            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="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">On admission</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#8211;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White-cell count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#8211;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelet count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#8211;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral blood smear<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 schistocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;2 schistocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haptoglobin &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3&#8211;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Direct coombs tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8211;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;52&#8211;1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sodium &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137&#8211;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5&#8211;5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate dehydrogenase &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2827&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">313&#8211;618&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">c-Reactive protein &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">URINALYSIS</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Protein &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leukocytes &#40;&#47;HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;5&#47;c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Red blood cells &#40;&#47;HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;2&#47;c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary protein to creatinine ratio &#40;mg&#47;mg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab989344.png"
              ]
            ]
            1 => 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="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Additional studies</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C3 &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9&#8211;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C4 &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1&#8211;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CH50 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#8211;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C1q &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118&#8211;244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C1q Inhibitor &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C2 &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ADAMTS13 activity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#8211;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-ADAMTS13 antibody &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum cryoglobulins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Auto-immune antibodies<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#44; Pregnancy test&#44; SPE&#44; Tumoral markers<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&#44; HIV&#44; HBV&#44; HCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&#47;Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood&#44; urine and stool cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Upper endoscopy&#44; colonoscopy&#44; cervical&#44; thoracic and abdominopelvic CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Irrelevant changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab989343.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peripheral blood smear was done to evaluate presence of erythrocyte fragmentation and is reported as schistocytes count in a microscopic field at 100&#215; magnification&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Antinuclear antibodies&#44; extractable nuclear antigens&#44; anti-neutrophil cytoplasmic antibodies&#44; glomerular basement membrane&#44; rheumatoid factor&#44; cyclic citrullinated peptide&#44; anticardiolipin&#47;anti-&#946;2-glycoprotein&#44; Lupus anticoagulant&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Carcinoembryonic antigen&#44; carbohydrate antigen 19-9&#44; &#945;-fetoprotein&#44; cancer antigen 125&#44; neuron-specific enolase&#44; NSE&#46;</p> <p class="elsevierStyleNotepara" id="npar0020"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ADAMTS13&#59; a disintegrin and metalloproteinase with a thrombospondin type 1 motif&#59; member 13&#46; CT&#59; computerized tomography&#46; HBV&#59; hepatitis B virus&#46; HCV&#59; hepatitis C virus&#46; HIV&#59; human immunodeficiency virus&#46; SPE&#59; serum protein electrophoresis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Laboratorial results on admission and additional studies to establish the cause of the thrombotic microangiopathy&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of atypical uraemic syndrome in the era of eculizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Fremeaux-Bacchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ckj/sfr177"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Kidney J"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26069738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical hemolytic uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Loirat"
                            1 => "V&#46; Fr&#233;meaux-Bacchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1750-1172-6-60"
                      "Revista" => array:5 [
                        "tituloSerie" => "Orphanet J Rare Dis"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21902819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en s&#237;ndrome hemol&#237;tico ur&#233;mico at&#237;pico&#58; diagn&#243;stico y tratamiento&#46; Documento de consenso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Campistol"
                            1 => "M&#46; Arias"
                            2 => "G&#46; Ariceta"
                            3 => "M&#46; Blasco"
                            4 => "M&#46; Espinosa"
                            5 => "J&#46;M&#46; Griny&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2012.Nov.11781"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "27"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23364625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mutations in components of complement influence the outcome of Factor I-associated atypical hemolytic uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Bienaime"
                            1 => "M&#46;A&#46; Dragon-Durey"
                            2 => "C&#46;H&#46; Regnier"
                            3 => "S&#46;C&#46; Nilsson"
                            4 => "W&#46;H&#46; Kwan"
                            5 => "J&#46; Blouin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2009.472"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2010"
                        "volumen" => "77"
                        "paginaInicial" => "339"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20016463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel C3 mutation p&#46;Lys65Gln in aHUS affects complement factor H binding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Volokhina"
                            1 => "D&#46; Westra"
                            2 => "X&#46; Xue"
                            3 => "P&#46; Gros"
                            4 => "N&#46; van de Kar"
                            5 => "L&#46; van den Heuvel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-012-2183-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "1519"
                        "paginaFinal" => "1524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22669319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of eculizumab for atypical haemolytic uraemic syndrome &#40;aHUS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Rathbone"
                            1 => "E&#46; Kaltenthaler"
                            2 => "A&#46; Richards"
                            3 => "P&#46; Tappenden"
                            4 => "A&#46; Bessey"
                            5 => "A&#46; Cantrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2013-003573"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2013"
                        "volumen" => "3"
                        "paginaInicial" => "e003573"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24189082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;M&#46; Legendre"
                            1 => "C&#46; Licht"
                            2 => "P&#46; Muus"
                            3 => "L&#46;A&#46; Greenbaum"
                            4 => "S&#46; Babu"
                            5 => "C&#46; Bedrosian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1208981"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "2169"
                        "paginaFinal" => "2181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23738544"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Noris"
                            1 => "J&#46; Caprioli"
                            2 => "E&#46; Bresin"
                            3 => "C&#46; Mossali"
                            4 => "G&#46; Pianetti"
                            5 => "S&#46; Gamba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.02210310"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "1844"
                        "paginaFinal" => "1859"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment and prognosis of thrombotic thrombocytopenic purpura-hemolytic uremic syndromes in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;A&#46; Kaplan"
                            1 => "J&#46;N&#46; George"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Uptodate"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eculizumab&#58; a review of its use in atypical haemolytic uraemic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;M&#46; Keating"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40265-013-0147-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs"
                        "fecha" => "2013"
                        "volumen" => "73"
                        "paginaInicial" => "2053"
                        "paginaFinal" => "2066"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24249647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001538/v1_201602110042/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48186"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cartas al Director"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003600000001/v1_201602110042/S0211699515001538/v1_201602110042/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001538?idApp=UINPBA000064"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Letter to the Editor
Eculizumab for the treatment of an atypical hemolytic uremic syndrome with mutations in complement factor I and C3
Eculizumab para el tratamiento de un síndrome urémico hemolítico atípico con mutaciones en los factores I y C3 del sistema del complemento
Emanuel Ferreiraa,
Autor para correspondencia
emanuelfeferreira@gmail.com

Corresponding author at: Servicio de Nefrología, Centro Hospitalar e Universitário de Coimbra–Hospital Geral., Rua do Buxo, lote 17, 3040-792 Coimbra, Portugal. Tel.: +351 916699039.
, Nuno Oliveiraa, Maria Marquesa, Luís Franciscob, Ana Santosa, Armando Carreiraa, Mário Camposc
a Servicio de Nefrología, Centro Hospitalar e Universitário de Coimbra–Hospital Geral, Coimbra, Portugal
b Servicio de Hematología, Centro Hospitalar e Universitário de Coimbra–Hospital Geral, Coimbra, Portugal
c Servicio de Nefrología, Centro Hospitalar e Universitário de Coimbra–Hospitais da Universidade de Coimbra, Coimbra, Portugal
Leído
10828
Veces
se ha leído el artículo
2686
Total PDF
8142
Total HTML
Compartir estadísticas
 array:24 [
  "pii" => "S0211699515001538"
  "issn" => "02116995"
  "doi" => "10.1016/j.nefro.2015.07.007"
  "estado" => "S300"
  "fechaPublicacion" => "2016-01-01"
  "aid" => "101"
  "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
  "copyrightAnyo" => "2015"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Nefrologia. 2016;36:72-5"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 5671
    "formatos" => array:3 [
      "EPUB" => 305
      "HTML" => 4601
      "PDF" => 765
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0211699515001381"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2015.08.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "86"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "cor"
    "cita" => "Nefrologia. 2016;36:75-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5482
      "formatos" => array:3 [
        "EPUB" => 387
        "HTML" => 4255
        "PDF" => 840
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "Methylmalonic acidemia with emergency hypertension"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "75"
          "paginaFinal" => "76"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Acidemia metilmal&#243;nica con hipertensi&#243;n de emergencia"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Bahareh Yaghmaei, Parastoo Rostami, Farnaz Najmi Varzaneh, Behdad Gharib, Behnaz Bazargani, Nima Rezaei"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Bahareh"
              "apellidos" => "Yaghmaei"
            ]
            1 => array:2 [
              "nombre" => "Parastoo"
              "apellidos" => "Rostami"
            ]
            2 => array:2 [
              "nombre" => "Farnaz Najmi"
              "apellidos" => "Varzaneh"
            ]
            3 => array:2 [
              "nombre" => "Behdad"
              "apellidos" => "Gharib"
            ]
            4 => array:2 [
              "nombre" => "Behnaz"
              "apellidos" => "Bazargani"
            ]
            5 => array:2 [
              "nombre" => "Nima"
              "apellidos" => "Rezaei"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001381?idApp=UINPBA000064"
    "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001381/v1_201602110042/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0211699515001411"
    "issn" => "02116995"
    "doi" => "10.1016/j.nefro.2015.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-01-01"
    "aid" => "89"
    "copyright" => "Sociedad Espa&#241;ola de Nefrolog&#237;a"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Nefrologia. 2016;36:69-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 10984
      "formatos" => array:3 [
        "EPUB" => 346
        "HTML" => 9417
        "PDF" => 1221
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director&#58; Comentarios breves sobre casos cl&#237;nicos</span>"
      "titulo" => "Nefritis intersticial aguda por ibuprofeno en poblaci&#243;n pedi&#225;trica"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "69"
          "paginaFinal" => "71"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Ibuprofen-induced acute interstitial nephritis in the paediatric population"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figura 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1974
              "Ancho" => 1658
              "Tamanyo" => 175863
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n temporal de las cifras de creatinina y urea&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ana Belen Mart&#237;nez L&#243;pez, Olalla &#193;lvarez Blanco, Augusto Luque de Pablos, Mar&#237;a Dolores Morales San-Jos&#233;, Ana Rodr&#237;guez Sanchez de la Blanca"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Ana Belen"
              "apellidos" => "Mart&#237;nez L&#243;pez"
            ]
            1 => array:2 [
              "nombre" => "Olalla"
              "apellidos" => "&#193;lvarez Blanco"
            ]
            2 => array:2 [
              "nombre" => "Augusto"
              "apellidos" => "Luque de Pablos"
            ]
            3 => array:2 [
              "nombre" => "Mar&#237;a Dolores"
              "apellidos" => "Morales San-Jos&#233;"
            ]
            4 => array:2 [
              "nombre" => "Ana"
              "apellidos" => "Rodr&#237;guez Sanchez de la Blanca"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2013251416000250"
        "doi" => "10.1016/j.nefroe.2016.02.004"
        "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/S2013251416000250?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001411?idApp=UINPBA000064"
    "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001411/v1_201602110042/es/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Eculizumab for the treatment of an atypical hemolytic uremic syndrome with mutations in complement factor I and C3"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "72"
        "paginaFinal" => "75"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Emanuel Ferreira, Nuno Oliveira, Maria Marques, Lu&#237;s Francisco, Ana Santos, Armando Carreira, M&#225;rio Campos"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "Emanuel"
            "apellidos" => "Ferreira"
            "email" => array:1 [
              0 => "emanuelfeferreira&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Oliveira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria"
            "apellidos" => "Marques"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Lu&#237;s"
            "apellidos" => "Francisco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Santos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Armando"
            "apellidos" => "Carreira"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#225;rio"
            "apellidos" => "Campos"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#44; Coimbra&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Hematolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#44; Coimbra&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospitais da Universidade de Coimbra&#44; Coimbra&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>&#58; Servicio de Nefrolog&#237;a&#44; Centro Hospitalar e Universit&#225;rio de Coimbra&#8211;Hospital Geral&#46;&#44; Rua do Buxo&#44; lote 17&#44; 3040-792 Coimbra&#44; Portugal&#46; Tel&#46;&#58; &#43;351 916699039&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Eculizumab para el tratamiento de un s&#237;ndrome ur&#233;mico hemol&#237;tico at&#237;pico con mutaciones en los factores I y C3 del sistema del complemento"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3462
            "Ancho" => 2454
            "Tamanyo" => 392693
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course&#58; laboratory data and treatment&#46; Corticosteroid therapy was started with intravenous administration of methylprednisolone &#40;1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 3 days&#41; followed by oral prednisolone and an initial dosage of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; This dosage was maintained until the 53rd day after admission&#44; with posterior tapering&#46; Rituximab &#40;arrows&#41; was administered at a dose of 600<span class="elsevierStyleHsp" style=""></span>mg &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m2&#41; on the 27th&#44; 34th&#44; 41st and 48th days after admission&#46; Cyclophosphamide &#40;arrowhead&#41; was administered in a single dose of 1000<span class="elsevierStyleHsp" style=""></span>mg on the 61st day after admission &#40;2nd day after readmission&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg for a week for 4 weeks&#44; started on the 158th day after admission&#44; followed by a dosage of 1200<span class="elsevierStyleHsp" style=""></span>mg 1 week later an then a maintenance dose of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks&#46; This dosage is still being continued&#46; We performed a total of 79 plasma exchange sessions&#46; The last three laboratorial test results were done on the 270th&#44; 340th and 466th days following first admission&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atypical hemolytic-uremic syndrome &#40;aHUS&#41; is a rare&#44; life-threatening complement-mediated thrombotic microangiopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Approximately half of cases have mutations in complement proteins but only 12&#37; have 2 or more mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Eculizumab is nowadays considered first-line therapy for aHUS&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old female with unremarkable past medical history presented with a 3-day history of decreased urine output&#46; Physical examination showed hypertension &#40;160&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41; and lower limbs edema&#46; Investigations revealed an acute thrombotic microangiopathy &#40;ATM&#41;&#44; hematuria and nephrotic proteinuria &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Daily plasmapheresis &#40;PMP&#41; was started immediately&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Investigations for secondary causes of ATM revealed a low ADAMTS 13 activity&#44; decreased complement C4&#44; C3&#44; C1q and C2 levels and positive serum cryoglobulins &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Considering the hypothesis of an autoimmune disorder&#44; we started 3 daily pulses of 1000<span class="elsevierStyleHsp" style=""></span>mg methylprednisolone followed by oral prednisolone&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">PMP was stopped on the eighteenth day of admission &#40;D18&#41; due to normal platelet count during 3 consecutive days &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On the D19 a renal biopsy was made&#46; It showed a &#8220;thrombotic microangiopathy with acute tubular necrosis&#8221; and &#8220;deposition of IgM&#44; C3 and C1q in the capillary wall&#8221;&#46; Due to increased hemolytic activity&#44; PMP was resumed on the D21&#46; On the D27&#44; rituximab was started to enhance immunosuppression&#46; PMP was stopped on the D35 based on the absence of schistocytosis&#44; hemoglobin stability and lactate dehydrogenase &#40;LDH&#41; normalization&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">On the D50&#44; LDH was high but hemoglobin and platelet count were stable&#46; A state of compensated hemolysis was assumed and the patient was discharged home&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ten days later she was readmitted due to increased hemolytic activity &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; PMP was resumed and 1000<span class="elsevierStyleHsp" style=""></span>mg cyclophosphamide was given&#46; At that time ADAMTS13 and complement C4 levels were normal but complement C3 levels remained low&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A genetic screening for mutations in complement regulatory proteins was made&#46; Two mutations were found in factor I &#40;C&#46; 452 A&#62;G&#44; pASN 151 Ser&#41; and C3 &#40;C193 A<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>C&#44; pLys 65 Gin&#41; proteins&#46; The process of eculizumab acquisition was lengthy&#44; wherefore this therapy was started only on the 98th day after readmission&#46; At that moment we were performing one PMP session&#47;week&#44; LDH remained high &#40;859<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41; and moderate renal dysfunction &#40;creatinine 2&#46;08<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and urea 60<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41; and nephrotic proteinuria persisted &#40;5&#46;2<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg per week for 4 weeks followed by subsequent doses of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks since the 5th week&#46; Complete hematologic remission was attained 2 days after eculizumab initiation&#46; The patient was discharged home on the 105th day after readmission&#46; Four weeks later&#44; proteinuria was only 0&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Currently&#44; 10 months after first infusion&#44; the patient remains under biweekly administration of eculizumab&#46; Hematologic remission persists and there is a significant recover of renal function &#40;urea 43<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; creatinine 1&#46;27<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Complement factor I &#40;CFI&#41; and C3 mutations account for 10&#37; and 4&#37; of the overall aHUS-associated mutations&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> C3 mutations are among the ones with the poorest prognosis&#58; 75&#37; risk of death or end stage renal failure &#40;ESRF&#41; at 3&#8211;5 years follow up and 50&#37; risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> CFI mutations have a 50&#8211;60&#37; risk of death and ESRF at 3&#8211;5 years follow up and 10&#8211;30&#37; risk of recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Both mutations present in our patient were previously reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> The p&#46;Asn151Ser mutation causes a quantitative deficiency of factor I<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and the p&#46;Lys65Gin mutation weakens the affinity of C3b to complement factor H&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the growing importance of eculizumab&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a> PMP remains the mainstay of treatment while waiting for the immunoglobulin&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Nonetheless&#44; its benefit depends on the underlying genetic defect &#8211; only 25&#37; and 57&#37; of those with CFI and C3 mutations&#44; respectively&#44; achieve remission&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In our patient&#44; PMP was critical to prevent further progression of renal failure and the development of other systemic involvement&#46; However&#44; as described by Loirat&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> it was unable to achieve complete and sustained remission&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">In our case&#44; the confounding presence of low ADAMTS13&#44; C4&#44; C2 and C1q levels&#44; the presence of cryoglobulins and the existence of immune deposits in the glomerular capillary wall led to the misdiagnosis of a thrombotic thrombocytopenic purpura secondary to an autoimmune disease&#46; It explains the preference for glucocorticoids&#44; rituximab and cyclophosphamide in relation to eculizumab&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Eculizumab is nowadays considered first-line therapy for aHUS&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It is a humanized monoclonal immunoglobulin IgG that targets C5 and blocks the uncontrolled generation of the cytotoxic membrane attack complex&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> When we started Eculizumab&#44; our patient was still PMP dependent despite the 79 PMP sessions&#46; Contrariwise&#44; complete hematologic remission was attained two days after first infusion and a remarkable recover of renal function and reduction of proteinuria was evident&#46; These findings reinforce the benefits of eculizumab in aHUS&#44; even in cases of severe renal involvement&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">In conclusion&#44; our case highlights the diagnostic challenge of aHUS and emphasizes the notion that isolated PMP is no longer the best therapeutic option in aHUS&#44; in which cases a prompt switch to eculizumab is mandatory&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3462
            "Ancho" => 2454
            "Tamanyo" => 392693
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical course&#58; laboratory data and treatment&#46; Corticosteroid therapy was started with intravenous administration of methylprednisolone &#40;1000<span class="elsevierStyleHsp" style=""></span>mg&#47;day for 3 days&#41; followed by oral prednisolone and an initial dosage of 60<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; This dosage was maintained until the 53rd day after admission&#44; with posterior tapering&#46; Rituximab &#40;arrows&#41; was administered at a dose of 600<span class="elsevierStyleHsp" style=""></span>mg &#40;375<span class="elsevierStyleHsp" style=""></span>mg&#47;m2&#41; on the 27th&#44; 34th&#44; 41st and 48th days after admission&#46; Cyclophosphamide &#40;arrowhead&#41; was administered in a single dose of 1000<span class="elsevierStyleHsp" style=""></span>mg on the 61st day after admission &#40;2nd day after readmission&#41;&#46; Eculizumab was administered at a dose of 900<span class="elsevierStyleHsp" style=""></span>mg for a week for 4 weeks&#44; started on the 158th day after admission&#44; followed by a dosage of 1200<span class="elsevierStyleHsp" style=""></span>mg 1 week later an then a maintenance dose of 1200<span class="elsevierStyleHsp" style=""></span>mg every 2 weeks&#46; This dosage is still being continued&#46; We performed a total of 79 plasma exchange sessions&#46; The last three laboratorial test results were done on the 270th&#44; 340th and 466th days following first admission&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:2 [
            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="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">On admission</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin &#40;g&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#8211;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White-cell count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#8211;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelet count &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&#8211;400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Peripheral blood smear<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 schistocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;2 schistocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haptoglobin &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;3&#8211;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Direct coombs tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#8211;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;52&#8211;1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sodium &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">137&#8211;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potassium &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;5&#8211;5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lactate dehydrogenase &#40;U&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2827&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">313&#8211;618&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">c-Reactive protein &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">URINALYSIS</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Protein &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leukocytes &#40;&#47;HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;5&#47;c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Red blood cells &#40;&#47;HPF&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;2&#47;c&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urinary protein to creatinine ratio &#40;mg&#47;mg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab989344.png"
              ]
            ]
            1 => 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="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Additional studies</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Normal range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C3 &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9&#8211;1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C4 &#40;g&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1&#8211;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CH50 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#8211;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C1q &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118&#8211;244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C1q Inhibitor &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180&#47;320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C2 &#40;mg&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#8211;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ADAMTS13 activity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40&#8211;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anti-ADAMTS13 antibody &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum cryoglobulins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Auto-immune antibodies<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&#44; Pregnancy test&#44; SPE&#44; Tumoral markers<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&#44; HIV&#44; HBV&#44; HCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&#47;Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood&#44; urine and stool cultures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Upper endoscopy&#44; colonoscopy&#44; cervical&#44; thoracic and abdominopelvic CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Irrelevant changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab989343.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peripheral blood smear was done to evaluate presence of erythrocyte fragmentation and is reported as schistocytes count in a microscopic field at 100&#215; magnification&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Antinuclear antibodies&#44; extractable nuclear antigens&#44; anti-neutrophil cytoplasmic antibodies&#44; glomerular basement membrane&#44; rheumatoid factor&#44; cyclic citrullinated peptide&#44; anticardiolipin&#47;anti-&#946;2-glycoprotein&#44; Lupus anticoagulant&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Carcinoembryonic antigen&#44; carbohydrate antigen 19-9&#44; &#945;-fetoprotein&#44; cancer antigen 125&#44; neuron-specific enolase&#44; NSE&#46;</p> <p class="elsevierStyleNotepara" id="npar0020"><span class="elsevierStyleItalic">Abbreviations</span>&#58; ADAMTS13&#59; a disintegrin and metalloproteinase with a thrombospondin type 1 motif&#59; member 13&#46; CT&#59; computerized tomography&#46; HBV&#59; hepatitis B virus&#46; HCV&#59; hepatitis C virus&#46; HIV&#59; human immunodeficiency virus&#46; SPE&#59; serum protein electrophoresis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Laboratorial results on admission and additional studies to establish the cause of the thrombotic microangiopathy&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of atypical uraemic syndrome in the era of eculizumab"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46; Fremeaux-Bacchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ckj/sfr177"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Kidney J"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26069738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atypical hemolytic uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Loirat"
                            1 => "V&#46; Fr&#233;meaux-Bacchi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1750-1172-6-60"
                      "Revista" => array:5 [
                        "tituloSerie" => "Orphanet J Rare Dis"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21902819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n en s&#237;ndrome hemol&#237;tico ur&#233;mico at&#237;pico&#58; diagn&#243;stico y tratamiento&#46; Documento de consenso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Campistol"
                            1 => "M&#46; Arias"
                            2 => "G&#46; Ariceta"
                            3 => "M&#46; Blasco"
                            4 => "M&#46; Espinosa"
                            5 => "J&#46;M&#46; Griny&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3265/Nefrologia.pre2012.Nov.11781"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nefrologia"
                        "fecha" => "2013"
                        "volumen" => "33"
                        "paginaInicial" => "27"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23364625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mutations in components of complement influence the outcome of Factor I-associated atypical hemolytic uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Bienaime"
                            1 => "M&#46;A&#46; Dragon-Durey"
                            2 => "C&#46;H&#46; Regnier"
                            3 => "S&#46;C&#46; Nilsson"
                            4 => "W&#46;H&#46; Kwan"
                            5 => "J&#46; Blouin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/ki.2009.472"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2010"
                        "volumen" => "77"
                        "paginaInicial" => "339"
                        "paginaFinal" => "349"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20016463"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Novel C3 mutation p&#46;Lys65Gln in aHUS affects complement factor H binding"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Volokhina"
                            1 => "D&#46; Westra"
                            2 => "X&#46; Xue"
                            3 => "P&#46; Gros"
                            4 => "N&#46; van de Kar"
                            5 => "L&#46; van den Heuvel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00467-012-2183-z"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Nephrol"
                        "fecha" => "2012"
                        "volumen" => "27"
                        "paginaInicial" => "1519"
                        "paginaFinal" => "1524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22669319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of eculizumab for atypical haemolytic uraemic syndrome &#40;aHUS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Rathbone"
                            1 => "E&#46; Kaltenthaler"
                            2 => "A&#46; Richards"
                            3 => "P&#46; Tappenden"
                            4 => "A&#46; Bessey"
                            5 => "A&#46; Cantrell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2013-003573"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2013"
                        "volumen" => "3"
                        "paginaInicial" => "e003573"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24189082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Terminal complement inhibitor eculizumab in atypical hemolytic-uremic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;M&#46; Legendre"
                            1 => "C&#46; Licht"
                            2 => "P&#46; Muus"
                            3 => "L&#46;A&#46; Greenbaum"
                            4 => "S&#46; Babu"
                            5 => "C&#46; Bedrosian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1208981"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2013"
                        "volumen" => "368"
                        "paginaInicial" => "2169"
                        "paginaFinal" => "2181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23738544"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Noris"
                            1 => "J&#46; Caprioli"
                            2 => "E&#46; Bresin"
                            3 => "C&#46; Mossali"
                            4 => "G&#46; Pianetti"
                            5 => "S&#46; Gamba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2215/CJN.02210310"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin J Am Soc Nephrol"
                        "fecha" => "2010"
                        "volumen" => "5"
                        "paginaInicial" => "1844"
                        "paginaFinal" => "1859"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20595690"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment and prognosis of thrombotic thrombocytopenic purpura-hemolytic uremic syndromes in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;A&#46; Kaplan"
                            1 => "J&#46;N&#46; George"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Uptodate"
                        "fecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eculizumab&#58; a review of its use in atypical haemolytic uraemic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;M&#46; Keating"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40265-013-0147-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Drugs"
                        "fecha" => "2013"
                        "volumen" => "73"
                        "paginaInicial" => "2053"
                        "paginaFinal" => "2066"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24249647"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/02116995/0000003600000001/v1_201602110042/S0211699515001538/v1_201602110042/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48186"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Cartas al Director"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003600000001/v1_201602110042/S0211699515001538/v1_201602110042/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0211699515001538?idApp=UINPBA000064"
]
Información del artículo
ISSN: 02116995
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 12 10 22
2024 Octubre 74 38 112
2024 Septiembre 74 36 110
2024 Agosto 93 55 148
2024 Julio 55 26 81
2024 Junio 75 38 113
2024 Mayo 81 31 112
2024 Abril 92 42 134
2024 Marzo 67 30 97
2024 Febrero 87 43 130
2024 Enero 63 25 88
2023 Diciembre 55 26 81
2023 Noviembre 65 35 100
2023 Octubre 71 40 111
2023 Septiembre 47 33 80
2023 Agosto 57 32 89
2023 Julio 66 26 92
2023 Junio 94 17 111
2023 Mayo 93 30 123
2023 Abril 60 12 72
2023 Marzo 101 27 128
2023 Febrero 64 21 85
2023 Enero 70 27 97
2022 Diciembre 75 38 113
2022 Noviembre 57 37 94
2022 Octubre 88 40 128
2022 Septiembre 64 36 100
2022 Agosto 55 53 108
2022 Julio 54 54 108
2022 Junio 33 37 70
2022 Mayo 61 49 110
2022 Abril 69 59 128
2022 Marzo 67 44 111
2022 Febrero 43 45 88
2022 Enero 42 36 78
2021 Diciembre 42 38 80
2021 Noviembre 38 42 80
2021 Octubre 54 54 108
2021 Septiembre 35 32 67
2021 Agosto 36 38 74
2021 Julio 44 38 82
2021 Junio 49 21 70
2021 Mayo 57 34 91
2021 Abril 104 67 171
2021 Marzo 84 34 118
2021 Febrero 83 24 107
2021 Enero 58 30 88
2020 Diciembre 59 23 82
2020 Noviembre 41 24 65
2020 Octubre 43 25 68
2020 Septiembre 46 31 77
2020 Agosto 57 30 87
2020 Julio 55 9 64
2020 Junio 61 23 84
2020 Mayo 66 20 86
2020 Abril 43 25 68
2020 Marzo 41 19 60
2020 Febrero 48 23 71
2020 Enero 60 24 84
2019 Diciembre 46 31 77
2019 Noviembre 57 37 94
2019 Octubre 52 21 73
2019 Septiembre 51 18 69
2019 Agosto 44 25 69
2019 Julio 46 26 72
2019 Junio 51 40 91
2019 Mayo 44 31 75
2019 Abril 77 24 101
2019 Marzo 58 24 82
2019 Febrero 46 20 66
2019 Enero 52 20 72
2018 Diciembre 152 43 195
2018 Noviembre 223 20 243
2018 Octubre 228 20 248
2018 Septiembre 92 15 107
2018 Agosto 69 10 79
2018 Julio 64 11 75
2018 Junio 95 11 106
2018 Mayo 112 10 122
2018 Abril 164 12 176
2018 Marzo 124 12 136
2018 Febrero 165 9 174
2018 Enero 82 7 89
2017 Diciembre 143 14 157
2017 Noviembre 83 13 96
2017 Octubre 52 6 58
2017 Septiembre 43 14 57
2017 Agosto 56 11 67
2017 Julio 56 19 75
2017 Junio 50 24 74
2017 Mayo 62 19 81
2017 Abril 45 7 52
2017 Marzo 38 27 65
2017 Febrero 42 11 53
2017 Enero 36 6 42
2016 Diciembre 56 11 67
2016 Noviembre 79 15 94
2016 Octubre 102 20 122
2016 Septiembre 127 8 135
2016 Agosto 132 1 133
2016 Julio 194 7 201
2016 Junio 121 0 121
2016 Mayo 162 0 162
2016 Abril 136 0 136
2016 Marzo 156 0 156
2016 Febrero 183 0 183
2016 Enero 54 0 54
2015 Diciembre 38 0 38
2015 Noviembre 74 0 74
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Nefrología
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?