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  • Title: Early recognition of renal toxicity of high-dose methotrexate therapy: a case report.
    Author: Nowicki TS, Bjornard K, Kudlowitz D, Sandoval C, Jayabose S.
    Journal: J Pediatr Hematol Oncol; 2008 Dec; 30(12):950-2. PubMed ID: 19131789.
    Abstract:
    A 10-year-old boy with osteosarcoma and normal renal function manifested laboratory evidence of impending renal toxicity and extreme elevation of aspartate aminotrasferase and alanine aminotransferase within 2 hours after the completion of a 4-hour infusion of high-dose methotrexate (MTX) (12 g/m2), and went on to develop acute renal failure with life-threatening hyperkalemia 29 hours later. Although his renal function recovered completely with high-dose leucovorin, hemodialysis, charcoal hemoperfusion, and carboxypeptidase G2, we present this case to emphasize that signs of renal toxicity may be present as early as 2 hours after the completion of a 4-hour MTX infusion, and to suggest that monitoring for MTX toxicity should perhaps begin within a few hours after the completion of 4-hour MTX infusion.
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