نبذة مختصرة : Introduction: Methotrexate is a drug with chemotherapeutic properties frequently used for the treatment of certain types of cancer. The following is a clinical case which, to the best of the authors’ knowledge, is the first report in Colombia on nephrotoxicity caused by this drug and describes the consequences as well as the treatment provided at a quaternary care hospital. Case report: A 71-year-old patient with a diagnosis of non-Hodgkin’s lymphoma with normal renal function underwent chemotherapy (high-dose methotrexate intravenously) and developed stage 3 acute renal failure according to the KDIGO guidelines, which was most likely related to methotrexate intake. The patient received treatment with intravenous fluids and sodium bicarbonate as promoters of urine excretion of the toxin, and oral calcium folinate following the institutional protocol. The patient was discharged with recovery of kidney function and improved creatinine and urea nitrogen levels. Conclusion: The treatment given to the patient in this case report shows that although methotrexate nephrotoxicity is a potentially serious entity, it can have a good prognosis if treated promptly. ; Introducción. El metotrexato es un fármaco con propiedades quimioterapéuticas usado de forma frecuente para el tratamiento de ciertos tipos de cáncer. A continuación, se presenta un caso clínico que, a conocimiento de los autores, es el primer reporte en Colombia sobre nefrotoxicidad por este medicamento, así como sus consecuencias y el manejo que se le dio en un hospital de cuarto nivel. Presentación del caso. Hombre de 71 años con diagnóstico de linfoma no Hodgkin y función renal normal, quien se sometió a tratamiento quimioterapéutico (metotrexato a altas dosis por vía endovenosa) y desarrolló insuficiencia renal aguda estadio 3 según las guías KDIGO, la cual muy probablemente se relacionaba al consumo de metotrexato. El paciente recibió manejo con líquidos endovenosos y bicarbonato de sodio como promotores de la eliminación renal del tóxico, así como ...
Relation: https://revistas.unal.edu.co/index.php/care/article/view/92651/84185; https://revistas.unal.edu.co/index.php/care/article/view/92651/84197; de Miguel D, García-Suárez J, Martín Y, Gil-Fernández JJ, Burgaleta C. Severe acute renal failure following high-dose methotrexate therapy in adults with haematological malignancies: A significant number result from unrecognized co-administration of several drugs. Nephrol Dial Transplant. 2008;23(12):3762-6. https://doi.org/fk35g4.; Yang SL, Zhao FY, Song H, Shen DY, Xu XJ. Methotrexate associated renal impairment is related to delayed elimination of high-dose Methotrexate. Scientific World Journal. 2015;2015:7517-03. https://doi.org/gb5vz9.; Green MR, Chamberlain MC. Renal dysfunction during and after high-dose methotrexate. Cancer Chemother Pharmacol. 2009;63(4):599-604. https://doi.org/df92bg.; Widemann BC, Adamson PC. Understanding and Managing Methotrexate Nephrotoxicity. Oncologist. 2006;11(6):694-703. https://doi.org/d8cgrv.; Ferreri AJM, Reni M, Foppoli M, Martelli M, Pangalis GA, Frezzato M, et al. High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet. 2009;374(9700):1512-20. https://doi.org/d5wtbg.; Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2):239-45. https://doi.org/cdpr97.; Perazella MA, Moeckel GW. Nephrotoxicity from chemotherapeutic agents: Clinical manifestations, pathobiology, and prevention/therapy. Semin Nephrol. 2010;30(6):570-81. https://doi.org/b564nt.; Amitai I, Rozovski U, El-Saleh R, Shimony S, Shepshelovich D, Rozen-Zvi B, et al. Risk factors for high-dose methotrexate associated acute kidney injury in patients with hematological malignancies. Hematol Oncol. 2020;38(4):584-8. https://doi.org/hhww.; Kitamura M, Kitamura S, Fujioka M, Kamijo R, Sato S, Sawayama Y, et al. Methotrexate-induced acute kidney injury in patients with hematological malignancies: three case reports with literature review. Ren Replace Ther. 2018;4(39):1-8. https://doi.org/hhwx.; Skärby T, Jönsson P, Hjorth L, Behrentz M, Björk O, Forestier E, et al. High-dose methotrexate: On the relationship of methotrexate elimination time vs renal function and serum methotrexate levels in 1164 courses in 264 Swedish children with acute lymphoblastic leukaemia (ALL). Cancer Chemother Pharmacol. 2003;51(4):311-20. https://doi.org/d24cv6.; Iqbal S, Armaghani A, Aiyer R, Kazory A. Methotrexate nephrotoxicity: Novel treatment, new approach. J Oncol Pharm Pract. 2013;19(4):373-6. https://doi.org/hhw3.; Howard SC, McCormick J, Pui CH, Buddington RK, Harvey RD. Preventing and Managing Toxicities of High‐Dose Methotrexate. Oncologist. 2016;21(12):1471-82. https://doi.org/f9jsmp.; Widemann BC, Schwartz S, Jayaprakash N, Christensen R, Pui CH, Chauhan N, et al. Efficacy of glucarpidase (carboxypeptidase G2) in patients with acute kidney injury after high-dose methotrexate therapy. Pharmacotherapy. 2014;34(5):427-39. https://doi.org/hhw4.; Shamash J, Earl H, Souhami R. Acetazolamide for alkalinisation of urine in patients receiving high-dose methotrexate. Cancer Chemother Pharmacol. 1991;28(2):150-1. https://doi.org/b58mdx.; Kramer E, Filtz M, Pace M. Evaluation of methotrexate clearance with an enteral urine alkalinization protocol for patients receiving high-dose methotrexate. J Oncol Pharm Pract. 2021;27(1):26-32. https://doi.org/hhw5.; Kinoshita A, Kurosawa Y, Kondoh K, Suzuki T, Manabe A, Inukai T, et al. Effects of sodium in hydration solution on plasma methotrexate concentrations following high-dose methotrexate in children with acute lymphoblastic leukemia. Cancer Chemother Pharmacol. 2003;51(3):256-60. https://doi.org/bf6823.; Widemann BC, Balis FM, Kim AR, Boron M, Jayaprakash N, Shalabi A, et al. Glucarpidase, leucovorin, and thymidine for high-dose methotrexate-induced renal dysfunction: Clinical and pharmacologic factors affecting outcome. J Clin Oncol. 2010;28(25):3979-86. https://doi.org/cn6n7v.; Ackland SP, Schilsky RL. High-Dose Methotrexate : A Critical Reappraisal. J Clin Oncol. 1987;5(12):2017-31. https://doi.org/hhw8.; Tuffaha HW, Al Omar S. Glucarpidase rescue in a patient with high-dose methotrexate-induced nephrotoxicity. J Oncol Pharm Pract. 2011;17(2):136-40. https://doi.org/fdn6jt.; Meyers PA, Flombaum C. High-dose methotrexate-induced renal dysfunction: Is glucarpidase necessary for rescue? J Clin Oncol. 2011;29(7):e180. https://doi.org/ctdknd.; Chan WKY, Hui WF. Sequential use of hemoperfusion and single-pass albumin dialysis can safely reverse methotrexate nephrotoxicity. Pediatr Nephrol. 2016;31(10):1699-703. https://doi.org/f8394p.; Kumar N, Shirali AC. What is the best therapy for toxicity in the setting of methotrexate-associated acute kidney injury: High-flux hemodialysis or carboxypeptidase G2? Semin Dial. 2014;27(3):226-8. https://doi.org/hhw9.; Connors NJ, Sise ME, Nelson LS, Hoffman RS, Smith SW. Methotrexate toxicity treated with continuous venovenous hemofiltration, leucovorin and glucarpidase. Clin Kidney J. 2014;7(6):590-2. https://doi.org/hhxb.; https://revistas.unal.edu.co/index.php/care/article/view/92651
Processing Request
No Comments.