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- Title
Successful rescue in a patient with high dose methotrexate-induced nephrotoxicity and acute renal failure.
- Authors
Kepka, L; De Lassence, A; Ribrag, V; Gachot, B; Blot, F; Theodore, C; Bonnay, M; Korenbaum, C; Nitenberg, G
- Abstract
We describe the case of a 35-year old male who developed acute renal failure following high dose methotrexate therapy for Burkitt's non Hodgkin lymphoma. Serum methotrexate levels reached 37 micromol/l, and remained higher than 1 micromol/l for more than a week. Folinic acid rescue was intensified to 200-400 mg intravenously every 4 hours. As methotrexate binds markedly to proteins, plasma exchange was initially chosen, 4 sessions being performed from day 2 to day 4. The methotrexate pharmacokinetic profile was not significantly modified during plasma exchange, and serum drug level was 3 micromol/l. Continuous veno-venous hemodiafiltration was therefore performed from day 5 to day 10. This procedure also seemed ineffective, with evidence of low ultrafiltrate clearance. No extrarenal toxicity was observed in our patient. Thus, conventional extrarenal procedures appear to have a limited role in the setting of overexposure to methotrexate. The use of very high doses of folinic acid in our case probably played a major role in the eventual favorable outcome.
- Publication
Leukemia & lymphoma, 1998, Vol 29, Issue 1-2, p205
- ISSN
1042-8194
- Publication type
Journal Article
- DOI
10.3109/10428199809058397