Severe renal toxicity due to intermediate-dose methotrexate

Cancer Chemother Pharmacol. 1989;24(4):243-5. doi: 10.1007/BF00257626.

Abstract

Methotrexate (MTX) is a drug widely used in the treatment of patients with malignant disease. Its well-known side effects include myelosuppression, mucositis and renal damage. These problems are primarily dose-related, tending to occur more frequently when high doses (greater than 1 g/m2) are given. We present four cases in whom severe renal and mucosal toxicity occurred with intermediate doses (200 mg/m2) of MTX despite folinic acid rescue. Possible reasons for this occurrence are discussed and means of avoiding such toxicity are suggested. Three of four patients developed severe loin pain within a few hours of injection; the significance of this symptom in relation to subsequent renal toxicity has implications for early recognition of the problem.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Back Pain
  • Bicarbonates / therapeutic use
  • Fluid Therapy
  • Humans
  • Hydrogen-Ion Concentration
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / prevention & control
  • Kidney Diseases / urine
  • Leucovorin / administration & dosage
  • Leucovorin / therapeutic use
  • Lymphoma, Non-Hodgkin / drug therapy
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Middle Aged
  • Mouth Mucosa
  • Mouthwashes
  • Sodium / therapeutic use
  • Sodium Bicarbonate
  • Stomatitis / chemically induced
  • Stomatitis / prevention & control

Substances

  • Bicarbonates
  • Mouthwashes
  • Sodium Bicarbonate
  • Sodium
  • Leucovorin
  • Methotrexate