Wang Cong-Ping
Eye & Ent Hospital of Fudan University, Shanghai 200031, China.
Iran J Pharm Res. 2016 Fall;15(4):957-961.
To investigate acute kidney injury (AKI) in children with acute lymphoblastic leukemia (ALL) who received high dose methotrexate (MTX) chemotherapy and explore the corresponding treatment. Methods 180 children who received high dose MTX chemotherapy were observed with serum MTX concentration and serum creatinine. Patients with AKI of stage 3 or poor response to conventional treatment were performed on hemodialysis and assessed the treatment outcome. Results 9 patients (5%) have appeared AKI, including 7 cases of AKI of stage 3. However, there were not any significant correlation between age, gender, serum MTX concentration and AKI, respectively. Compared with normal serum MTX concentration, the patients with high serum MTX concentration easily were developed to AKI, the MTX and serum creatinine concentration had been significantly decreased in 9 patients after hemodialysis. Conclusion AKI has appeared in some children with ALL who receive high dose MTX chemotherapy, and this may due to increase of serum MTX concentration. The monitoring of serum MTX concentration and AKI index could help to find out AKI, and even to prevent the occurrence of it. Furthermore, once AKI is present, those patients with AKI stage 3 or poor response to conventional treatment should be performed on hemodialysis treatment.
探讨接受大剂量甲氨蝶呤（MTX）化疗的急性淋巴细胞白血病（ALL）患儿急性肾损伤（AKI）情况并探索相应治疗方法。方法 观察180例接受大剂量MTX化疗患儿的血清MTX浓度及血清肌酐情况。对3期AKI或对传统治疗反应不佳的患者进行血液透析并评估治疗效果。结果 9例（5%）出现AKI，其中3期AKI 7例。然而，年龄、性别、血清MTX浓度与AKI之间分别无显著相关性。与血清MTX浓度正常者相比，血清MTX浓度高者更容易发生AKI，9例患者血液透析后MTX及血清肌酐浓度均显著下降。结论 部分接受大剂量MTX化疗的ALL患儿出现了AKI，这可能与血清MTX浓度升高有关。监测血清MTX浓度及AKI指标有助于发现AKI，甚至预防其发生。此外，一旦出现AKI，3期AKI或对传统治疗反应不佳的患者应进行血液透析治疗。
