Renal damage methotrexate

When serum methotrexate concentrations are high, leu-covorin (folinic acid) rescue may protect against renal damage. Methotrexate concentrations are only transiently lowered by hemoperfusion, and they are unaffected by peritoneal dialysis once there is acute renal insufficiency. Sustained reductions in drug concentrations and recovery of renal function have been reported after charcoal hemoperfusion followed by hemodialysis (63,64). 

Renal - Methotrexate may cause renal damage that may lead to acute renal failure. Close attention to renal function including adequate hydration, urine alkalinization and measurement of serum methotrexate and creatinine levels are essential for safe administration. 

Urinary tract Methotrexate-induced renal damage appears to be physicochemical in nature. Both the parent compound and its major metabolite, 7-hydroxymethotrexate, are less soluble at acidic pH values, increasing the risk of precipitation in the kidneys, particularly at high dosages. An amorphous yellow material—very probably methotrexate—has been isolated in the kidneys of patients who died as a result of methotrexate-induced renal dysfunction. For physicochemical reasons, it is recommended that the urine be alkalinized (target urinary pH above 7.5) before intensive methotrexate regimens are started. Supportive agents include sodium bicarbonate orally or intravenously, acetazolamide 500 mg qds, or both in combination [1805, 18F, 182 ]. If there is acute renal insufficiency despite appropriate urinary alkalinization, one may need to use carboxypeptidase G2 as an antidote, which is also appropriate in cases of accidental intrathecal overdose of methotrexate [183", 184 ]. 

In patients with psoriasis treated with methotrexate, hepatic damage is common however, among patients with inflammatory bowel disease and rheumatoid arthritis, the risk is significantly lower. Renal insufficiency may increase risk of hepatic accumulation and toxicity. 

METHOTREXATE CISPLATIN t methotrexate levels, with t risk of pulmonaiy toxicity Cisplatin is the most common anticancer drug associated with renal proximal and distal tubular damage. Cisplatin could significantly l renal elimination of methotrexate It would be best to start with lower doses of methotrexate. It is necessary to assess renal function prior to and during concurrent treatment until stability is achieved. Monitor clinically and with pulmonary function tests... 

Cisplatin is the most common anticancer drug associated with renal proximal and distal tubular damage. Cisplatin could significantly i renal elimination of methotrexate... 

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