Intravenous immunoglobulin-associated acute renal failure: case series and literature review

Intravenous immunoglobulin (IVIg) is widely used in the treatment of immunodeficient and autoimmune hematologic, neurologic, rheumatologic, and cutaneous disorders. The major adverse effects of IVIg infusions are pain (chest, hip, joint, and back), fever, chills, and fatigue. These effects are related to the rate of the infusion and may be attenuated by slowing the rate. The addition of sugar excipients to IVIg formulations has reduced the frequency and severity of these adverse effects but may increase the frequency of acute renal failure. We describe four patients who experienced acute renal failure after IVIg administration. In each patient, the IVIg formulation contained significant amounts of sucrose, and the patient's renal function returned to baseline after discontinuation of therapy. Clinicians should be familiar with patients who are at increased risk of acute renal failure secondary to IVIg administration. Furthermore, IVIg preparations that contain high amounts of sucrose should be administered with caution in these high-risk patients.