Síndrome hemafagocítico, enfrentamiento diagnóstico y terapéutico actual. Revisión a partir de un caso relacionado a virus Epstein-Barr / Hemophagocytic syndrome, current diagnostic and therapeutic approach

Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a highly lethal hyper-inflammatory disorder that leads to a storm of cytokines, hemophagocytosis and multiple organ failure. It can be primary, which is inherited, or secondary. In the latter, virus infections are a frequent trigger, predominantly the family of herpes viruses, such as Epstein-Barr virus. An early treatment is recommended. Until recently there was no consensus about the management of secondary cases. The protocols for the treatment of primary HLH were used, which include cytotoxic agents and corticosteroids. We herein review the current diagnostic and therapeutic approach of HLH, based on a case associated with a reactivation of the Epstein-Barr virus in an immunocompetent adolescent. We highlight the importance of suspecting this disease in patients with a persistent inflammatory response state or with a fever of unknown origin, in order to carry out a timely treatment, with the least toxicity, and appropriate to the characteristics of each individual, which is the current therapeutic trend.

Efectos crónicos y tratamiento con litio sobre la anatomía y función renal / Chronic effects of lithium treatment in renal anatomy and function

Lithium is a drug widely used in clinical psychiatry, often as first-line treatment. However, it has generated much controversy because of the likely adverse effects of both acute and chronic use, mainly in the kidney. With respect to prolonged exposure to lithium, it would be detrimental to the kidneys at variable extent, depending on factors such as duration of treatment, dosage of drug, patient age, renal damage, prior comorbidities, among others not yet sufficiently elucidated. The principal mechanism of renal function changes was determined by morphological changes, such as interstitial nephritis, interstitial-medullar fibrosis and tubular atrophy, all irreversible phenomena that ultimately lead to a tubuloglomerular imbalance and commitment of the GFR. Other aspects of chronic nephropathy induced by lithium and their production mechanisms are being studied, also the search and advanced diagnostic techniques to predict and / or detect early changes. Among them have described the pathology (renal biopsy), although this form of diagnosis is very late. Thus it seeks the introduction of imaging and serological markers of kidney failure as tools that provide information about kidney condition earlier.

El Litio es un fármaco ampliamente utilizado en psiquiatría, muchas veces como tratamiento de primera línea. Existe en la actualidad una activa controversia acerca de sus probables efectos adversos a nivel renal, tanto agudos como crónicos, ya que la exposición prolongada al Litio sería deletérea para el riñón en una magnitud variable, dependiendo de factores como duración del tratamiento, dosis del fármaco, edad del paciente, daño renal previo y comorbilidad, entre otros aún no suficientemente dilucidados. El origen del mecanismo principal de alteración de la función renal estaría en alteraciones morfológicas como la Nefritis Intersticial, la Fibrosis Intersticio-Medular y la Atrofia Tubular, todos fenómenos irreversibles que finalmente conducirían a un desbalance tubuloglomerular y a un compromiso de la VFG. Otros aspectos de la Neuropatía Crónica inducida por Litio y de sus mecanismos de producción se encuentran en estudio, así como también la búsqueda y perfeccionamiento de técnicas diagnósticas que permitan predeciry/o detectar tempranamente los cambios mencionados. Entre estas últimas se ha descrito la anatomía patológica (biopsia renal), aunque esta es una forma de diagnóstico muy tardía. Es por ello que se busca la introducción de la imagenología y de marcadores serológicos de falla renal como herramientas que entreguen información sobre la condición del riñón más precozmente.