Friday, June 17, 2011

CLINICAL CASE 38, ANSWERS AND SUMMARY

Which of these options are treatment options for management of methotrexate nephrotoxicity?

GI decontamination
  4 (14%)
Aggresive hydration
  8 (28%)
Urinary Alkalinization
  14 (50%)
Leucovorin( IV)
  13 (46%)
Leucovorin (PO)
  5 (17%)
CPDG glucarpidase
  3 (10%)
Recurrent intermittent Hemodialysis
  4 (14%)
Continuous venovenous dialysis
  3 (10%)

MTX ( methotrexate) is a chemo agent that is nephrotoxic.  At high doses, it and its metabolite can accumulate and can cause acute tubular injury.  Dosages higher than 1000mg/m2 are what is associated with renal damage. Most oncologists use prevention strategies with hydration and leucovorin to help combat this side effect.
What helps decrease MTX levels:- all the above listed are right answers. The glucarpidase is a new agent that is experimental but has shown some promise.  

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