Recovery of methotrexate-induced anuric acute kidney injury after glucarpidase therapy. (19th April 2017)

• Record Type: Journal Article
• Authors: Harms, James; Khawaja, Ayaz; Taylor, Maria; Han, Xiaosi; Mrug, Michal
• Is Part Of: SAGE open medical case reports. Volume 5(2017)
• Publication Date: 2017-04-19
• Subjects: High-dose methotrexate -- methotrexate -- acute kidney injury -- continuous renal replacement therapy; Clinical medicine -- Case studies -- Periodicals; 616.09
• DOI: 10.1177/2050313X17705050
• Languages: English
• ISSNs: 2050-313X

Abstract

Objectives: This case report describes two cases of high-dose methotrexate–induced nephrotoxicity: death in the case of conventional supportive care and successful renal function recovery in a patient treated with glucarpidase and continuous dialysis. Methods: High dose methotrexate is widely used for management of adult and pediatric malignancies. However, high-dose methotrexate–induced renal nephrotoxicity may cause severe, even lethal complications. Here we present examples of such outcomes. Results: We present one case of lethal high-dose methotrexate nephrotoxicity in a patient treated with conventional rescue therapy. We contrast this outcome with another patient with high-dose methotrexate–induced anuric acute kidney injury, who has recovered renal function following therapy with glucarpidase and continuous dialysis. Conclusions: This is only the second reported case of high-dose methotrexate–induced anuric acute kidney injury, and the only one with a reported clinical outcome. This first report of recovery from high-dose methotrexate–induced anuric acute kidney injury after glucarpidase administration supports available evidence pointing to the effectiveness of this therapy.