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Ramamoorthy SK, Hephziba R. Acute renal failure post high dose methotrexate infusion successfully managed with high dose folinic Acid and high flux dialysis. Indian J Hematol Blood Transfus. 2012;29(2):90-2doi: 10.1007/s12288-011-0143-6.
Ramamoorthy, S. K., & Hephziba, R. (2013). Acute renal failure post high dose methotrexate infusion successfully managed with high dose folinic Acid and high flux dialysis. Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion, 29(2), 90-2. https://doi.org/10.1007/s12288-011-0143-6
Ramamoorthy, Suthanthira Kannan, and Hephziba, R. "Acute renal failure post high dose methotrexate infusion successfully managed with high dose folinic Acid and high flux dialysis." Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion vol. 29,2 (2013): 90-2. doi: https://doi.org/10.1007/s12288-011-0143-6
Ramamoorthy SK, Hephziba R. Acute renal failure post high dose methotrexate infusion successfully managed with high dose folinic Acid and high flux dialysis. Indian J Hematol Blood Transfus. 2013 Jun;29(2):90-2. doi: 10.1007/s12288-011-0143-6. Epub 2012 Jan 11. PMID: 24426345; PMCID: PMC3636355.
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Indian J Hematol Blood Transfus. 2013 Jun;29(2):90-2. doi: 10.1007/s12288-011-0143-6. Epub 2012 Jan 11.

Acute renal failure post high dose methotrexate infusion successfully managed with high dose folinic Acid and high flux dialysis.

Indian journal of hematology & blood transfusion : an official journal of Indian Society of Hematology and Blood Transfusion

Suthanthira Kannan Ramamoorthy, R Hephziba

Affiliations

  1. C Block, VNCC, G Kuppusamy Naidu Memorial Hospital, Coimbatore, 641037 India.

PMID: 24426345 PMCID: PMC3636355 DOI: 10.1007/s12288-011-0143-6

Abstract

High dose methotrexate infusion has become the standard of care in pediatric and adult acute lymphoblastic leukemia management. Adequate hydration, alkalinization of urine and optimal folinic acid rescue are the key factors in the prevention of toxicity. The development of acute renal failure after high dose methotrexate infusion is very rare, albeit a few cases have been reported in literature. Various options have been available in addition to high dose folinic acid rescue, such as ultra filtration dialysis, continuous extracorporeal therapy, thymidine and Glucarpidase infusion to directly counter act excess methotrexate. In a developing country with limited reserves, managing a patient who develops acute renal failure immediately after high dose methotrexate is a nightmare without Glucarpidase. We report here a case that has been managed successfully with intensive supportive measures alone.

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