Intravenous immunoglobulin renal insufficiency

Renal insufficiency after high dosages of intravenous immunoglobulin has been observed, mostly in patients with pre-existing renal disease (81). Acute renal insufficiency occurred within 7 days after the administration of intravenous immunoglobulin, with a peak at 5 days. About 40% of patients needed dialysis and 15% died despite treatment (all with severe underlying diseases) the mean time to recovery in survivors was about 10 days (82). 

The pathophysiology of acute renal insufficiency due to immunoglobulins is probably related to hyperosmolar renal damage, due to sucrose present in 50 ml intravenous formulations (13,43,85-87). Acute renal insufficiency has also been attributed to sucrose in a kidney allograft... 

Acute renal insufficiency after intravenous immunoglobulin therapy has been reported in association with the injection of iodinated radiocontrast agents (144). Contrast media and intravenous immunoglobuhn formulations containing maltose or sucrose both have toxic effects on renal cells. 

In a 38-year-old man with end-stage renal insufficiency and thrombocytopenia secondary to systemic lupus erythematosus, pseudohyponatremia occurred after treatment with intravenous immunoglobulin 1 g/kg for 2 days (146). 

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