Blood purification therapies in methotrexate-induced acute kidney injury: Four case reports

Emi Fujikura, Maho Akiu, Kenichiro Miyauchi, Mai Yoshida, Satoshi Aoki, Tae Yamamoto, Kaori Narumi, Noriko Yanagisawa, Takashi Nakamichi, Mariko Miyazaki, Hiroshi Sato, Sadayoshi Ito

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Methotrexate (MTX), a folic acid antimetabolite, is administered at a high dose for the treatment of diseases such as leukemia and malignant lymphoma. Often, an effort is made to reduce the adverse effects of MTX by monitoring MTX concentration in the blood and administering a high dose of leucovorin. However, side effects of MTX are still reported. MTX is metabolized in the liver and eliminated via the kidneys; hence, blood purification therapy is useful for the reduction of MTX blood concentration in case of renal impairment. Case presentation: We performed various types of blood purification therapies in four cases of MTX poisoning that accompanied renal impairment. Conclusions: Based on our results, we concluded that hemodialysis or hemoperfusion with an activated carbon absorption column was useful for the elimination of MTX from the blood. It is important to choose an appropriate blood purification method understanding the characteristics of each blood purification method.

Original languageEnglish
Article number48
JournalRenal Replacement Therapy
Issue number1
Publication statusPublished - 2017 Nov 23


  • Acute kidney injury
  • Blood purification therapy
  • High-dose methotrexate
  • Reduction rates

ASJC Scopus subject areas

  • Urology
  • Transplantation
  • Nephrology


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