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Successful rescue in a patient with high dose methotrexate-induced nephrotoxicity and acute renal failure

Leuk Lymphoma. 1998 Mar;29(1-2):205-9. doi: 10.3109/10428199809058397.

Abstract

We describe the case of a 35-year old male who developed acute renal failure following high dose methotrexate therapy for Burkitt's non Hodgkin lymphoma. Serum methotrexate levels reached 37 micromol/l, and remained higher than 1 micromol/l for more than a week. Folinic acid rescue was intensified to 200-400 mg intravenously every 4 hours. As methotrexate binds markedly to proteins, plasma exchange was initially chosen, 4 sessions being performed from day 2 to day 4. The methotrexate pharmacokinetic profile was not significantly modified during plasma exchange, and serum drug level was 3 micromol/l. Continuous veno-venous hemodiafiltration was therefore performed from day 5 to day 10. This procedure also seemed ineffective, with evidence of low ultrafiltrate clearance. No extrarenal toxicity was observed in our patient. Thus, conventional extrarenal procedures appear to have a limited role in the setting of overexposure to methotrexate. The use of very high doses of folinic acid in our case probably played a major role in the eventual favorable outcome.

Publication types

  • Case Reports

MeSH terms

  • Acute Kidney Injury / chemically induced
  • Acute Kidney Injury / metabolism
  • Acute Kidney Injury / therapy*
  • Adult
  • Antidotes / therapeutic use*
  • Burkitt Lymphoma / complications
  • Burkitt Lymphoma / drug therapy
  • Burkitt Lymphoma / metabolism
  • Dose-Response Relationship, Drug
  • Humans
  • Leucovorin / therapeutic use*
  • Male
  • Methotrexate / adverse effects*
  • Methotrexate / pharmacokinetics

Substances

  • Antidotes
  • Leucovorin
  • Methotrexate