HIGH-DOSE METHOTREXATE-ASSOCIATED ACUTE RENAL FAILURE MAY BE AN AVOIDABLE COMPLICATION

Abstract

A 17-year-old boy with acute lymphoblastic leukemia developed acute renal failure within 48 h of an intravenous high-dose methotrexate (5 g/m²) infusion. His renal function returned to baseline 14 days later with supportive care, folinic acid rescue, and urinary alkalinization. A retrospective review revealed that the patient had been exposed to iopamidol, an intravenous contrast medium, on the day prior to the commencement of methotrexate treatment. Methotrexate-associated nephropathy is a rare complication in pediatric oncology, and a review of the literature suggests that exposure to nephrotoxic agents may be a significant but perhaps underrecognized risk factor for its development.

Keywords:

• acute lymphoblastic leukemia
• contrast media
• iopamidol
• kidney diseases
• chemically induced
• kidney failure
• acute
• methotrexate