SPONTANEOUS URBAN EXPANSION AROUND HISTORIC TOWN CENTERS AND ITS IMPACT ON ARCHITECTURAL IDENTITY - THE TOWN OF BIDYA AS A CASE STUDY
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Date
2025-12-14
Authors
Khursani, Ahmad Abed- Al-Qadir
Journal Title
Journal ISSN
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Publisher
An-Najah National University
Abstract
Background: High-dose methotrexate (HDMTX) is defined as doses of 500 mg/m2 or
higher administered intravenously and is a commonly used agent for the treatment of
haematological malignancies. However, HDMTX carriers a significant risk of
nephrotoxicity particularly acute kidney injury (AKI), which can delay treatment,
increase toxicity, and worsen outcomes. Defining the incidence and predicting renal
impairment in patients receiving HDMTX is necessary to enhance patient safety and aid
in therapeutic decision-making in Palestinian practice.
Objective: To assess the incidence of renal impairment in patients treated with HDMTX
for haematological malignancies and to evaluate the clinical, laboratory, and treatment-
related factors that were associated with the risk of renal impairment.
Methods: We conducted a retrospective cohort study at a tertiary educational referral
hospital in Palestine with a 120-bed capacity. All patients diagnosed with hematologic
malignancy and treated with HDMTX from 1 January 2016 to 31 December 2024 (data
extraction completed on 25 August 2025) were included. The study team reviewed and
extracted data from medical records, including demographic information (age, gender,
BMI, BSA), comorbidities (diabetes, hypertension, cardiovascular disease, liver disease),
laboratory parameters (baseline and post-treatment creatinine, BUN, eGFR, electrolytes,
liver enzymes, hematologic parameters), and treatment-related variables (protocols, dose
of MTX, leucovorin rescue, supportive medications). Descriptive statistics, Chi-square
tests, Mann–Whitney U tests (for non-parametric data).
Results: The incidence of AKI in patients receiving HDMTX was 9.8%. Patients with
AKI were more likely to have a higher baseline creatinine, lower eGFR,
hypoalbuminemia, and more comorbidity. Use of concomitant nephrotoxic medications
(aminoglycosides and vancomycin) was also significantly linked to AKI.
Conclusion: Renal damage as a result of HDMTX treatment continues to be a major
complication for patients with hematological malignancies in Palestine. Identifying
patients at risk early by methodical targeting, frequent monitoring, and providing
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appropriate supportive care can help mitigate nephrotoxicity and increase treatment
success.
Keywords: HDMTX, acute kidney injury, hematological malignancies, renal damage,
nephrotoxicity, Palestine