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The utility of online haemodiafiltration in methotrexate poisoning
Mohamed Said Abdelsalam1, Mohammed Mahdi Althaf2, Osman Alfurayh2
1Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Ar-Riyadh, Saudi Arabia Internal Medicine Department, Faculty of Medicine, Alexandria University, Egypt.
Abstract:
Summary We report a case of a 56-year-old woman with a high-grade diffuse large B-cell lymphoma who unexpectedly developed toxic plasma levels of methotrexate (MTX) following the first cycle of rituximab-cyclophosphamide, hydroxydanorubicin, oncovin, prednisolone (R-CHOP) with a high-dose MTX chemotherapy protocol. She also developed non-oliguric acute kidney injury secondary to MTX nephrotoxicity. We elected to treat her with online-haemodiafiltration (HDF) and this proved to be efficient with a dramatic response. Rapid clearance of MTX to therapeutic levels was possible within three sessions. Prompt therapy with high-volume online-HDF is an effective choice for rapid MTX clearance and swift reversal of MTX nephrotoxicity.
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