Zusammenfassung
Methotrexat (MTX) in „Low-dose“-Applikation ist eine wichtige Säule der antientzündlichen Therapie der rheumatoiden Arthritis und anderer entzündlicher Gelenkerkrankungen. Im Gegensatz zur „High-dose“-Anwendung von MTX in der Onkologie, das zur direkten Tubulustoxizität und zum konsekutiven Nierenversagen führen kann, sind renale Nebenwirkungen bei Low-dose-MTX eine seltene Ausnahme. Das größere Problem unter Low-dose-MTX liegt darin, dass eine a priori eingeschränkte Nierenfunktion durch Komorbiditäten oder eine zunehmende, manchmal klinisch nichtausreichend beachtete Niereninsuffizienz im Rahmen einer Komedikation mit z. B. nichtsteroidalen Antirheumatika (NSAR), Antibiotika etc. zu einer verminderten MTX-Ausscheidung und damit Kumulation der Substanz im Serum führt. Dies geht in erster Linie mit gastrointestinaler Mukositis und Knochenmarkdepression einher. Aus diesem Grund sollte auch Low-dose-MTX bei einer glomerulären Filtrationsrate (GFR) <30 ml/min gar nicht und bei einer GRF zwischen 30 und 60 ml/min nur in halbierter Regeldosis unter engmaschigen Kontrollen der Nierenfunktion gegeben werden.
Abstract
Methotrexate (MTX) in low-doses is an important component of anti-inflammatory therapy of rheumatoid arthritis and other inflammatory joint diseases. In contrast to high-dose administration of MTX in oncology, which can lead to direct tubulus toxicity and subsequent renal failure, renal side-effects are a rare exception for low-dose MTX. The biggest problem under low-dose MTX is that an already limited renal function due to comorbidities or an increasing, sometimes clinically insufficiently monitored renal insufficiency due to comedications, such as non-steroidal antirheumatics (NSAR) and antibiotics, leads to a reduced excretion of MTX and therefore to an accumulation in serum. This is primarily accompanied by gastrointestinal mucositis and bone marrow depression. For this reason low-dose MTX should never be administered once the glomerular filtration rate (GFR) is less than <30 ml/min and only 50% of the original dosage should be administered if the GFR is between 30 and 60 ml/min.
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Erdbrügger, U., de Groot, K. Nierenschädigung durch Methotrexat?. Z. Rheumatol. 70, 549–552 (2011). https://doi.org/10.1007/s00393-011-0830-6
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DOI: https://doi.org/10.1007/s00393-011-0830-6