[Acute renal failure following treatment with intravenously administered immunoglobulins]

A 74-year-old woman with insulin-dependent diabetes mellitus type 2 developed severe, reversible renal failure due probably to the administration of high doses of intravenous immunoglobulins (IVIG) for Guillain-Barré syndrome. The preparation administered did not contain sucrose or mannitol as adjuvants. The risk factors for the development of acute renal failure include pre-existent diabetes mellitus, reduced renal function and advanced age. In approximately 150 case reports in the literature, acute renal failure developed mainly after the use of sucrose-containing IVIG preparations. The course of both the onset of and the recovery from the renal failure and the histopathological findings in the described patient were in accordance with these findings. Since other causes were unlikely and in view of the supportive finding of elevated colloid osmotic pressure, it was concluded that the renal failure in this case was probably mediated by the oncotic effect of the macromolecular immunoglobulin itself.