Acute renal failure associated with intravenous immunoglobulins

Intravenous immunoglobulins (i.v.IG) are increasingly used in various clinical situations for which they have been considered to be safe and effective. However, since 1987, some cases of renal toxicity have been reported. Forty-nine cases of acute renal failure have been notified to the French Regional Pharmacovigilance Centers between 1992 and mid 1998. In this series, marked serum creatinine increases (mean 387%+/-181%) appeared within 8 h to 8 days after initiation of i.v.IG therapy. Oliguria was observed in 80% of the cases. Haemodialysis was required for 34% of the patients. The renal failure persisted for a mean duration of 10 days after discontinuation of the i.v.IG treatment. Although risk factors have not been definitely established, preexisting renal impairment and old age seem to predispose to i.v.IG-associated acute renal failure as well as diabetes mellitus or the use of diuretics. The mechanism of renal injury remains speculative but a hyperoncotic overloading may be contributory. Finally, close monitoring of renal function is required in patients with preexisting renal failure, with older age and with diabetes mellitus.