1988 Volume 29 Issue 11 Pages 2127-2131
A 6-year-old boy with acute lymphocytic leukemia (common ALL, FAB L1), diagnosed in December 1984, developed interstitial nephritis during maintenance chemotherapy. He attained a complete remission, and after CNS prophylaxis (2,400 rads cranial irradiation with intrathecal methotrexate) he was receiving maintenance chemotherapy. In September 1986, he complained of thirst and polyuria. Urine volume was 1.5-6 1/day and its specific gravity was below 1.010. Vasopressin test and water deprivation test indicated nephrogenic diabetes insipidus. Hydrochlorothiazide was administered and urine volume was well controlled. In January 1987, the patient was given antibiotics because of fever due to chemotherapy-induced leukopenia and developed deteriorated renal function. The renal biopsy revealed edema and mononuclear cell infiltration in interstitial tissues and degeneration of tubular epithelial cells with intact glomeruli, confirming the diagnosis of interstitial nephritis. We speculate that direct renal tubular damage by anti-cancer agents like methotrexate may have caused interstitial nephritis in this patient.
