Changes in glomerular filtration rate associated with high-dose methotrexate therapy in adults
Howell, S.B.; Carmody, J.
Cancer Treatment Reports 61(7): 1389-1391
1977
ISSN/ISBN: 0361-5960 PMID: 303938 Document Number: 112121
This study indicates that large subclinical changes in GFR with urinary alkalinization. Most cancer patients had a small reversible drop in GFR and this occurred within the first 2 h following MTX injection. The magnitude of the acute fall in GFR was proportional to the MTX dose. In some patients, GFR continued to fall during the subsequent 6 h. In some, partial recovery was already evident by 6-8 h after treatment. GFR returned toward baseline in all patients followed with serial GFR determination up to 24 h after MTX injection. The observation of relatively minor changes in GFR associated with high dose MTX therapy in adults stands in contrast to Link et al who found major changes in insulin clearance in children. The discrepancies between these 2 studies suggest that alkalinization alters the influence of high dose MTX therapy on subclinical changes in GFR by whatever mechanism this occurs, since, with the exception of age, the major difference in the 2 study populations was the use of alkalinization in the adults.