title: Early recognition of renal toxicity of high-dose methotrexate therapy: a case report.
abstract: A 10-year-old boy with osteosarcoma and normal renal function manifested laboratory evidence of impending renal toxicity and extreme elevation of aspartate aminotrasferase and alanine aminotransferase within 2 hours after the completion of a 4-hour infusion of high-dose methotrexate (MTX) (12 g/m2), and went on to develop acute renal failure with life-threatening hyperkalemia 29 hours later. Although his renal function recovered completely with high-dose leucovorin, hemodialysis, charcoal hemoperfusion, and carboxypeptidase G2, we present this case to emphasize that signs of renal toxicity may be present as early as 2 hours after the completion of a 4-hour MTX infusion, and to suggest that monitoring for MTX toxicity should perhaps begin within a few hours after the completion of 4-hour MTX infusion.
authors.affiliation: Division of Pediatric Hematology-Oncology, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY 10595, USA.
authors.forename: Theodore Scott
authors.initials: TS
authors.lastname: Nowicki
authors.forename: Kari
authors.initials: K
authors.lastname: Bjornard
authors.forename: David
authors.initials: D
authors.lastname: Kudlowitz
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandoval
authors.forename: Somasundaram
authors.initials: S
authors.lastname: Jayabose
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000150:complications / Q000188:drug therapy*; D002648:Child; D016903:Drug Monitoring; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D012516:Osteosarcoma / Q000150:complications / Q000188:drug therapy*; D011623:gamma-Glutamyl Hydrolase / Q000627:therapeutic use
chemical_list: D000964:Antimetabolites, Antineoplastic; D011623:gamma-Glutamyl Hydrolase; D002955:Leucovorin; D008727:Methotrexate