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Renal function features in pediatric acute lymphoblastic leukemia during high-dose methotrexate chemotherapy

  • Adkhiatul Muslihatin ,
  • Mia Ratwita Andarsini ,
  • Andi Cahyadi ,
  • Risky Vitria Prasetyo ,
  • I Dewa Gede Ugrasena ,
  • Maria Christina Shanty Larasanti ,


Introduction: High-dose Methotrexate (HD-MTX), a chemotherapy agent for acute lymphoblastic leukemia, is a cytotoxic agent for some organs, including kidneys. One of the most important toxicities due to HD-MTX is acute kidney injury due to Methotrexate crystallization in renal tubules. The prevalence of Acute kidney injury due to HD-MTX administration in pediatric ALL in dr. Soetomo General Hospital was unknown. The study aims to analyze renal function features in pediatric ALL during HD-MTX chemotherapy.

Methods: An analytical observational study with a prospective approach was conducted at Dr. Soetomo General Hospital Surabaya from December 2021 - July 2022. The subjects were ALL children aged 1-18 years who met inclusion and exclusion criteria. High-dose Methotrexate chemotherapy was given 3 times every 2 weeks during the consolidation phase. Laboratory examinations were performed before and after HD-MTX chemotherapy. Laboratory results were recorded to determine the GFR value. The difference test was performed using Wilcoxon signed rank test and the Friedman test with a significance value of p<0.05.

Results: A total of 20 subjects, the median age was 78 months old, and boys and girls were equal. Standard Risk of ALL was in 55% of subjects, and 45% were at high risk. There was no significant difference in laboratory parameters between before and after HD-MTX chemotherapy in all cycles with a p-value >0.05. The median value of GFR in each cycle is 257.5; 243.5; 228.5. Minimal GFR was 119 ml/min/1.73 m2, and maximum GFR was 638 ml/min/1.73 m2. It showed a median value of GFR in all cycles was >175 ml/min/m2 (hyperfiltration).

Conclusions: We concluded there was no AKI due to HD-MTX chemotherapy in pediatric ALL. It may be caused by providing adequate hydration, urine alkalinization, and leucovorin rescue.


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How to Cite

Muslihatin, A., Andarsini, M. R. ., Andi Cahyadi, Risky Vitria Prasetyo, I Dewa Gede Ugrasena, & Maria Christina Shanty Larasanti. (2022). Renal function features in pediatric acute lymphoblastic leukemia during high-dose methotrexate chemotherapy. Bali Medical Journal, 11(3), 1587–1590.




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Adkhiatul Muslihatin
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Mia Ratwita Andarsini
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Andi Cahyadi
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Risky Vitria Prasetyo
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I Dewa Gede Ugrasena
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Maria Christina Shanty Larasanti
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