SUCCESSFUL RESCUE IN A PATIENT WITH HIGH-DOSE METHOTREXATE-INDUCED NEPHROTOXICITY AND ACUTE-RENAL-FAILURE

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.