PP-081 SEVERE RENAL FAILURE DUE TO HIGH DOSE METHOTREXATE IN ACUTE LYMPHOBLASTIC LEUKEMIA ASSOCIATED WITH PREDISPOSING FACTORS: CASE REPORT

Abstract

Introduction: High dose methotrexate induced acute tubular damages is an important oncologic emergency in spite of preventive supportive treatment such as closely monitoring, leucovorin, hydration and alkalization. We report a case of severe renal insufficiency due to Hyper-CVAD in an acute lymphoblastic leukemia (ALL) with contributing factors such as diabetes and hypertension. Case: Hyper-CVAD was started to a 45 years old male ALL patient. He had diagnosis of diabetes mellitus and hypertension previously. After high-dose methotrexate infusion, preventive treatments such as adequate hydration and optimal dose folinic acid were given. Initially, the value of creatinine was 0.82 mg/dL. Despite preventive treatment, on the twelfth day of chemotherapy, creatinine value began to increase rapidly and acute renal failure occurred. Creatinine increased to 7.76 mg/dL and he became anuric. Dialysis and adequate supportive treatments were started immediately. He was monitored in the intensive care unit because of worsening of general condition. On the eighth day of acute renal failure the patient’s urine output has begun and septic shock improved during the course. The patient was discharged eventually. Discussion: High-dose methotrexate induced acute renal failure is a rare condition according to the other side effects of methotrexate. This rare side effect, in the presence of underlying predisposing factors may be more frequent and more severe. As in our case, even at normal creatinine values, while applying high-dose methotrexate we believe patients must be monitored closely for toxicity, adequate dose and duration of preventive treatment must be done and if possible dose adjustment would be appropriate especially in the presence of predisposing conditions to renal failure such as diabetes and hypertension.