Acute renal failure after high-dose methotrexate therapy in a patient with ileostomy.
High-dose methotrexate (HD-MTX) is an important treatment for Burkitt lymphoma, but can cause hepatic and renal toxicity when its clearance is delayed. We report a case of acute renal failure after HD-MTX therapy in a patient with ileostomy, The patient was a 3-year-old boy who had received a living-related liver transplantation for congenital biliary atresia. At day 833 after the transplantation, he was diagnosed with PTLD (post-transplantation lymphoproliferative disorder, Burkitt-type malignant lymphoma). During induction therapy, he suffered ileal perforation and ileostomy was performed. Subsequent HD-MTX therapy caused acute renal failure that required continuous hemodialysis. We supposed that intravascular hypovolemia due to substantial drainage from the ileostoma caused acute prerenal failure. After recovery of his renal function, we could safely treat the patient with HD-MTX therapy by controlling drainage from ileostoma with total parenteral nutrition.
ASADA
Dai
D
Department of Pediatrics, Kyoto University Hospital.
MATSUBARA
Hiroshi
H
KATO
Itaru
I
OSADA
Kazuko
K
URYU
Kumiko
K
TOKUMASU
Mayu
M
UMEDA
Katsutsugu
K
WATANABE
Ken-Ichiro
K
ADACHI
Souichi
S
OKAMOTO
Shinya
S
UEMOTO
Shinji
S
NAKAHATA
Tatsutoshi
T
D058186:Acute Kidney Injury / Q000209:etiology*; D001656:Biliary Atresia / Q000601:surgery; D002051:Burkitt Lymphoma / Q000188:drug therapy / Q000209:etiology; D002675:Child, Preschool; D004322:Drainage; D006801:Humans; D020896:Hypovolemia / Q000209:etiology; D007081:Ileostomy; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*
D008727:Methotrexate