Is low-dose methotrexate nephrotoxic? Case report and review of the literature.
Methotrexate (MTX) has become the most commonly prescribed disease-modifying anti-rheumatic drug. However, toxicity is an important drawback of MTX therapy and permanent discontinuation of MTX for adverse effects occurs in 1 patient out of 10. Although high-dose MTX is known to be nephrotoxic, data on low-dose MTX renal effects are scanty. We report an insidious and progressive deterioration of renal function during long-term low-dose MTX in a 59-year-old woman. Kidney biopsy revealed advanced kidney fibrosis with extensive interstitial and glomerular fibrosis, and vascular sclerosis. We suggest that patients on low-dose MTX therapy even alone, should be periodically monitored for creatinine levels.
Izzedine
H
H
Department of Nephrology, 83, Blvd de l'Hopital, Pitié-Salpêtrière Hospital, 75013 Paris, France. hassan.izzedine@psl.ap-hop-paris.fr
Launay-Vacher
V
V
Karie
S
S
Caramella
C
C
de Person
F
F
Deray
G
G
D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000473:pathology
D018501:Antirheumatic Agents; D008727:Methotrexate