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 #Methotrexate #Renal #Toxicity #management #treatment #nephrology
