title: Severe renal toxicity due to intermediate-dose methotrexate.
abstract: Methotrexate (MTX) is a drug widely used in the treatment of patients with malignant disease. Its well-known side effects include myelosuppression, mucositis and renal damage. These problems are primarily dose-related, tending to occur more frequently when high doses (greater than 1 g/m2) are given. We present four cases in whom severe renal and mucosal toxicity occurred with intermediate doses (200 mg/m2) of MTX despite folinic acid rescue. Possible reasons for this occurrence are discussed and means of avoiding such toxicity are suggested. Three of four patients developed severe loin pain within a few hours of injection; the significance of this symptom in relation to subsequent renal toxicity has implications for early recognition of the problem.
authors.affiliation: Department of Haematology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
authors.forename: A N
authors.initials: AN
authors.lastname: Stark
authors.forename: G
authors.initials: G
authors.lastname: Jackson
authors.forename: P J
authors.initials: PJ
authors.lastname: Carey
authors.forename: S
authors.initials: S
authors.lastname: Arfeen
authors.forename: S J
authors.initials: SJ
authors.lastname: Proctor
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain; D001639:Bicarbonates / Q000627:therapeutic use; D005440:Fluid Therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control / Q000652:urine; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009061:Mouth Mucosa; D009067:Mouthwashes; D012964:Sodium / Q000627:therapeutic use; D017693:Sodium Bicarbonate; D013280:Stomatitis / Q000139:chemically induced / Q000517:prevention & control
chemical_list: D001639:Bicarbonates; D009067:Mouthwashes; D017693:Sodium Bicarbonate; D012964:Sodium; D002955:Leucovorin; D008727:Methotrexate