L. Kepka et al., SUCCESSFUL RESCUE IN A PATIENT WITH HIGH-DOSE METHOTREXATE-INDUCED NEPHROTOXICITY AND ACUTE-RENAL-FAILURE, Leukemia & lymphoma, 29(1-2), 1998, pp. 205-209
We describe the case of a 35-year old male who developed acute renal f
ailure following high dose methotrexate therapy for Burkitt's non Hodg
kin lymphoma. Serum methotrexate levels reached 37 mu mol/l, and remai
ned higher than 1 mu mol/l for more than a week. Folinic acid rescue w
as intensified to 200-400 mg intravenously every 4 hours. As methotrex
ate binds markedly to proteins, plasma exchange was initially chosen,
4 sessions being performed from day 2 to day 4. The methotrexate pharm
acokinetic profile was not significantly modified during plasma exchan
ge, and serum drug level was 3 mu mol/l. Continuous veno-venous hemodi
afiltration was therefore performed from day 5 to day 10. This procedu
re also seemed ineffective, with evidence of low ultrafiltrate clearan
ce. No extrarenal toxicity was ol,served in our patient. Thus, convent
ional extrarenal procedures appear to have a limited role: in the sett
ing of overexposure to methotrexate. The use of very high doses of fol
inic acid in our case probably played a major role in the eventual fav
orable outcome.