Is low-dose methotrexate nephrotoxic? Case report and review of the literature

• Published in: Clinical nephrology Vol. 64; no. 4; p. 315
• Main Authors: Izzedine, H, Launay-Vacher, V, Karie, S, Caramella, C, de Person, F, Deray, G
• Format: Journal Article
• Language: English
• Published: Germany 01.10.2005
• Subjects: Antirheumatic Agents - adverse effects; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Biopsy; Female; Follow-Up Studies; Humans; Kidney Glomerulus - drug effects; Kidney Glomerulus - pathology; Methotrexate - adverse effects; Methotrexate - therapeutic use; Middle Aged; Renal Insufficiency - chemically induced; Renal Insufficiency - pathology
• ISSN: 0301-0430
• DOI: 10.5414/cnp64315

Methotrexate (MTX) has become the most commonly prescribed disease-modifying anti-rheumatic drug. However, toxicity is an important drawback of MTX therapy and permanent discontinuation of MTX for adverse effects occurs in 1 patient out of 10. Although high-dose MTX is known to be nephrotoxic, data on low-dose MTX renal effects are scanty. We report an insidious and progressive deterioration of renal function during long-term low-dose MTX in a 59-year-old woman. Kidney biopsy revealed advanced kidney fibrosis with extensive interstitial and glomerular fibrosis, and vascular sclerosis. We suggest that patients on low-dose MTX therapy even alone, should be periodically monitored for creatinine levels.