Methotrexate Renal Toxicity 

Prevention:

 • Alkalinize the urine, keep urine ph >7

 • Start pre-treatment 12 hours prior to 48 hours post

Treatment:

 • Hydration with bicarbonate based fluids till you see metabolic alkalosis

 • Forced diuresis (no data)

 • Leucovorin: should be continued until levels of methotrexate fall below 0.05 micromol/L

 • Glucarpidase: rapid lowering of level in 15min

 • Dialysis: Albumin bound- so not great clearance but high flux for 6 hours can help. Rebound effect is common.



Dr. Kenar Jhaveri @kdjhaveri



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