High-dose methotrexate-associated acute renal failure may be an avoidable complication.
A 17-year-old boy with acute lymphoblastic leukemia developed acute renal failure within 48 h of an intravenous high-dose methotrexate (5 g/m2) infusion. His renal function returned to baseline 14 days later with supportive care, folinic acid rescue, and urinary alkalinization. A retrospective review revealed that the patient had been exposed to iopamidol, an intravenous contrast medium, on the day prior to the commencement of methotrexate treatment. Methotrexate-associated nephropathy is a rare complication in pediatric oncology, and a review of the literature suggests that exposure to nephrotoxic agents may be a significant but perhaps underrecognized risk factor for its development.
Fong
Cheuk-Ming
CM
Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.
Lee
Anselm C W
AC
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D016896:Treatment Outcome
D002955:Leucovorin; D008727:Methotrexate