title: Sequential use of hemoperfusion and single-pass albumin dialysis can safely reverse methotrexate nephrotoxicity.
abstract: High-dose methotrexate therapy (HDMTX) is a common form of chemotherapy used in children with high-grade malignancy such as osteosarcoma. Treatment with HDMTX requires careful monitoring of drug levels with folinic acid (leucovorin) rescue therapy. Toxicity from methotrexate is not uncommon and sometimes causes significant morbidity and mortality.
  
  
  
  We report an 11-year-old child whose 24-h post-HDMTX serum level was 651.8 μmol/L (recommended level <20 μmol/L), which was complicated by septic shock and progressive renal and liver failure. As carboxypeptidase (glucarpidase) was not available locally, she was treated with the sequential use of charcoal hemoperfusion (CHP) and single-pass albumin dialysis (SPAD). The patient recovered without complications. Both liver and renal function recovered with no significant late sequelae.
  
  
  
  CHP and SPAD are effective extracorporeal methods of removing methotrexate. They provide alternative treatment options for critical care nephrologists in the management of methotrexate toxicity.
authors.affiliation: Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, SAR, China. chankyw@ha.org.hk.
authors.forename: Winnie Kwai Yu
authors.initials: WK
authors.lastname: Chan
authors.affiliation: Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, SAR, China.
authors.forename: Wun Fung
authors.initials: WF
authors.lastname: Hui
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy*; D000418:Albumins; D000931:Antidotes / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002606:Charcoal; D002648:Child; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use*; D008727:Methotrexate / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D000418:Albumins; D000931:Antidotes; D000964:Antimetabolites, Antineoplastic; D002606:Charcoal; D002955:Leucovorin; D008727:Methotrexate
keywords: Hemoperfusion; Methotrexate; Pediatrics; Single-pass albumin dialysis; Toxicity