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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Acknowledgments
We thank Dr. Ramachandran, Nephrologist, GKNM hospital for providing ultra filtration dialysis support and Dr. Satya Yadav, Gangaram hospital, Delhi and Dr. Peter Shaw, Children’s hospital at Westmead, Australia for helping us to get the Carboxypeptidase vials, even though they remain unused.
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Ramamoorthy, S.K., 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 29, 90–92 (2013). https://doi.org/10.1007/s12288-011-0143-6
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DOI: https://doi.org/10.1007/s12288-011-0143-6