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NDT Advance Access published online on September 8, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn503
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Severe acute renal failure following high-dose methotrexate therapy in adults with haematological malignances: a significant number result from unrecognized co-administration of several drugs

Dunia de Miguel, Julio García-Suárez, Yolanda Martín, Juan José Gil-Fernández and Carmen Burgaleta

Service of Haematology, Department of Medicine, Príncipe de Asturias University Hospital, University of Alcalá, Alcalá de Henares, Madrid, Spain

Correspondence and offprint requests to: Dunia de Miguel, Servicio de Hematología, Hospital Universitario Príncipe de Asturias, Carretera Alcalá-Meco S/N (Campus Universitario), 28805 Alcalá de Henares, Madrid, Spain. Tel: +34-91-8878100; Fax: +34-91-8812510; E-mail: duniamll@hotmail.com

Keywords: gemfibrozil; high-dose methotrexate; piperacillin—tazobactam; risk factors; severe renal failure

The first 150 words of the full text of this article appear below.



   Introduction
 
High-dose methotrexate (HDMTX, >1 g/m2) administered as an intravenous (i.v.) infusion is an important component in the treatment regimens for a variety of cancers [1]. HDMTX-associated severe acute renal failure (ARF) is an infrequent but serious complication because MTX is predominantly excreted in the urine. Data from a number of studies performed in the 1970s showed that a sustained elevation of serum MTX concentrations at 24 h (≥5 µmol/L), 48 h (≥1 µmo/L) and 72 h (≥0.1 µmo/L) after the start of the MTX infusion is considered to be toxic. The usual serum MTX level 48 h after HDMTX is <0.1 µmol/L. In the era of optimal supported care the incidence of grade 3–4 ARF after HDMTX has decreased from 10% to 0.6% in solid-cancer patients [2]. However, to our knowledge, the current incidence of HDMTX-associated severe ARF is unknown in adult . . . [Full Text of this Article]



   Methods
 
Patients
Study design and patient monitoring
Analysis of risk factors
Treatment strategies


   Results
 
Incidence and clinical findings
Patient 1
Patient 2
Risk factors


   Discussion
 

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