Mashhadi Mohammad Ali, Kaykhaei Mahmoud Ali, Sanadgol Houshang
Division of Oncology and Hematology, Department of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
Iran J Kidney Dis. 2012 Mar;6(2):105-9.
Methotrexate is an antifolate medication frequently used in the treatment of malignant and nonmalignant diseases. The usage of high-dose methotrexate was limited to patients with osteosarcoma, Ewing sarcoma, lymphoma, and acute lymphoblastic leukemia. One of the major side effects of high-dose methotrexate is nephropathy. The aim of present study was to determine the renal side effects of high-dose methotrexate in patients with malignancies.
In a study of 102 patients with osteosarcoma (n = 72), Ewing sarcoma (n = 15), and lymphoma (n = 15), treated with high-dose methotrexate, clinical and laboratory data including kidney function tests were recorded at baseline and during follow-up visits. The mean duration of follow-up was 6 months.
The mean age of the patients was 19.5 years (range, 5 to 80 years). The total courses of methotrexate therapy were 273 (median, 2.67 per patient). The mean creatinine level was 0.82 mg/dL. Of the 102 patients, 3 (2.9%) developed acute kidney injury with an at risk phase. Another patient (1.0%) developed acute kidney injury and its phase was injury according to the RIFLE criteria. None of the cases were failed and acute kidney injury was alleviated in all of the affected patients.
Our data revealed a low prevalence of acute kidney injury with high-dose methotrexate therapy. In addition, these toxicities were limited to the first and second phases of the RIFLE classification, all of which resolved spontaneously.
甲氨蝶呤是一种常用于治疗恶性和非恶性疾病的抗叶酸药物。高剂量甲氨蝶呤的使用仅限于骨肉瘤、尤因肉瘤、淋巴瘤和急性淋巴细胞白血病患者。高剂量甲氨蝶呤的主要副作用之一是肾病。本研究的目的是确定高剂量甲氨蝶呤对恶性肿瘤患者的肾脏副作用。
在一项对102例接受高剂量甲氨蝶呤治疗的骨肉瘤患者（n = 72）、尤因肉瘤患者（n = 15）和淋巴瘤患者（n = 15）的研究中，记录了基线和随访期间的临床和实验室数据，包括肾功能测试。平均随访时间为6个月。
患者的平均年龄为19.5岁（范围为5至80岁）。甲氨蝶呤治疗的总疗程为273个（中位数为每位患者2.67个）。平均肌酐水平为0.82mg/dL。在102例患者中，3例（2.9%）出现了有风险期的急性肾损伤。另1例患者（1.0%）出现了急性肾损伤，根据RIFLE标准，其阶段为损伤期。所有病例均未发展为肾衰竭，所有受影响患者的急性肾损伤均得到缓解。
我们的数据显示，高剂量甲氨蝶呤治疗导致急性肾损伤的发生率较低。此外，这些毒性仅限于RIFLE分类的第一和第二阶段，所有这些均自发缓解。
