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Methotrexate induced pneumatosis intestinalis under hemodialysis patient

Akira Mima1, Dai Nagahara1, Kosuke Tansho1

  • 1Department of Nephrology, Kindai University Nara Hospital, Kindai University Faculty of Medicine, Nara, Japan.

Hemodialysis International. International Symposium on Home Hemodialysis
|July 7, 2016
PubMed

Insights

Methotrexate (MTX) can induce pneumatosis intestinalis (PI) in patients undergoing hemodialysis (HD). High-flux HD may mitigate MTX toxicity, potentially improving this rare gastrointestinal condition.

Area of Science:

  • Gastroenterology
  • Nephrology
  • Pharmacology

Background:

  • Pneumatosis intestinalis (PI) is a rare condition involving gas in the intestinal wall.
  • Methotrexate (MTX) is a medication used for autoimmune diseases.
  • Hemodialysis (HD) is a treatment for kidney failure.

Observation:

  • A 46-year-old male with rheumatoid arthritis on HD developed epigastric pain and diarrhea after starting MTX.
  • Abdominal CT revealed significant intestinal edema and free intraperitoneal air, indicative of PI.

Findings:

  • This case represents the first reported instance of MTX-induced PI in a patient undergoing hemodialysis.
  • MTX is generally contraindicated in patients with chronic kidney disease.

Implications:

  • Physicians should exercise caution when prescribing MTX to patients with chronic kidney disease, especially those on HD.
  • High-flux HD might reduce MTX toxicity and oxidative stress, potentially offering a protective effect against PI.
Keywords:
Pneumatosis intestinalis (PI)chronic kidney disease (CKD)hemodialysis (HD)methotrexate (MTX)

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