内容紹介
Successful Treatment of High-Dose Methotrexate-Induced Oliguric Acute Renal Failure by Using a Combination of Hemodialysis Filtration and Direct Hemoperfusion
Summary
A 64-year-old man with central nervous system metastases from systemic non-Hodgkin lymphoma was treated with high-dose intravenous methotrexate(MTX 3.5 g/m2). The patient subsequently developed oliguric acute renal failure 12 hours after MTX initiation, and his serum MTX level was 163 μM at 26 hours. Hemodialysis filtration(HDF)combined with direct hemoperfusion(DHP)was initiated at 45 hours. Seven sessions of combined HDF and DHP and 2 courses of HDF alone were performed, and the mean MTX extraction rates were 68.2% and 74.3%, respectively. The patient experienced severe respiratory failure, febrile neutropenia, myelosuppression, and oral mucositis. However, his urine output began to improve on day 7 after MTX initiation, and his renal function gradually recovered. His serum MTX level declined to 0.04 μM on day 23 after MTX initiation. In the present case, we immediately initiated HDF and DHP and successfully treated the patient for MTX-induced renal failure.
要旨
症例は64歳,男性。脳転移のある悪性リンパ腫に対し大量メトトレキサート(MTX)療法を行った。MTX開始12時間後より乏尿性急性腎不全を合併し,MTX開始26時間後のMTX血中濃度は163 μMであった。MTX開始45時間後より血液透析濾過(HDF)+血液吸着(DHP)を計7回施行し,さらにその後HDFを単独で2回施行した。平均MTX除去率はそれぞれ68.2%,74.3%であった。重篤な呼吸不全,発熱性好中球減少症,骨髄抑制および口腔粘膜炎を認めた。尿量はMTX開始7日後より回復し,腎機能も改善した。MTX血中濃度が0.04 μMに低下したのはMTX開始23日後であった。本症例では大量MTX療法直後に乏尿性急性腎不全を来したが,HDF+DHPを早急に導入し救命することができた。
目次
Summary
A 64-year-old man with central nervous system metastases from systemic non-Hodgkin lymphoma was treated with high-dose intravenous methotrexate(MTX 3.5 g/m2). The patient subsequently developed oliguric acute renal failure 12 hours after MTX initiation, and his serum MTX level was 163 μM at 26 hours. Hemodialysis filtration(HDF)combined with direct hemoperfusion(DHP)was initiated at 45 hours. Seven sessions of combined HDF and DHP and 2 courses of HDF alone were performed, and the mean MTX extraction rates were 68.2% and 74.3%, respectively. The patient experienced severe respiratory failure, febrile neutropenia, myelosuppression, and oral mucositis. However, his urine output began to improve on day 7 after MTX initiation, and his renal function gradually recovered. His serum MTX level declined to 0.04 μM on day 23 after MTX initiation. In the present case, we immediately initiated HDF and DHP and successfully treated the patient for MTX-induced renal failure.
要旨
症例は64歳,男性。脳転移のある悪性リンパ腫に対し大量メトトレキサート(MTX)療法を行った。MTX開始12時間後より乏尿性急性腎不全を合併し,MTX開始26時間後のMTX血中濃度は163 μMであった。MTX開始45時間後より血液透析濾過(HDF)+血液吸着(DHP)を計7回施行し,さらにその後HDFを単独で2回施行した。平均MTX除去率はそれぞれ68.2%,74.3%であった。重篤な呼吸不全,発熱性好中球減少症,骨髄抑制および口腔粘膜炎を認めた。尿量はMTX開始7日後より回復し,腎機能も改善した。MTX血中濃度が0.04 μMに低下したのはMTX開始23日後であった。本症例では大量MTX療法直後に乏尿性急性腎不全を来したが,HDF+DHPを早急に導入し救命することができた。