title: [Successful treatment of high-dose methotrexate-induced oliguric acute renal failure by using a combination of hemodialysis filtration and direct hemoperfusion].
abstract: A 64-year-old man with central nervous system metastases from systemic non-Hodgkin lymphoma was treated with high- dose intravenous methotrexate(MTX 3.5 g/m2). The patient subsequently developed oliguric acute renal failure 12 hours after MTX initiation, and his serum MTX level was 163 mM at 26 hours. Hemodialysis filtration(HDF)combined with direct hemoperfusion(DHP)was initiated at 45hours. Seven sessions of combined HDF and DHP and 2 courses of HDF alone were performed, and the mean MTX extraction rates were 68.2% and 74.3%, respectively. The patient experienced severe respiratory failure, febrile neutropenia, myelosuppression, and oral mucositis. However, his urine output began to improve on day 7 after MTX initiation, and his renal function gradually recovered. His serum MTX level declined to 0.04 mM on day 23 after MTX initiation. In the present case, we immediately initiated HDF and DHP and successfully treated the patient for MTX-induced renal failure.
authors.affiliation: Dept. of Pharmacy, Nagoya City West Medical Center.
authors.forename: Issei
authors.initials: I
authors.lastname: Morozumi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Inagaki
authors.forename: Shinkichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sato
authors.forename: Hiroka
authors.initials: H
authors.lastname: Ogura
authors.forename: Norihiro
authors.initials: N
authors.lastname: Suga
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komatsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wakita
authors.forename: Koichi
authors.initials: K
authors.lastname: Yamada
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000628:therapy*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D006464:Hemoperfusion; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate