[Intravenous immunoglobulins and acute renal failure: mechanism and prevention]

Acute renal failure (ARF) is a rare complication of the use of intravenous immunoglobulins (IVIg) with an estimated incidence lower than 1 %. It is related to acute tubulo-interstitial nephropathy due to to the occurrence of osmotic nephrosis mainly in the proximal tubule. The recovery of renal function usually occurs within ten days. The risk factors for the occurrence of ARF during the use of IVIg are: age > 65 years, preexisting renal failure (creatinine clearance < 60 ml/min), diabetes, dose, hypovolemia, the concomitant use of other nephro-toxic agents (contrast media agents, etc.). IVIg related ARF has been reported mainly with saccharose-containing IVIg but also with maltose and glucose-containing IVIg. However, no definite conclusion can be drawn concerning the role of the stabilising agent in the genesis of ARF due to the larger use of saccharose-containing IVIG compared to other IVIG and the absence of controlled trials comparing various types of IVIg. Clinicians must be aware that ARF may occur with all types of IVIg. In patients with at least one risk factor for ARF, diuretics should be discontinued, an hydration using saline solutions should be started and the concomitant administration of other nephrotoxic drugs be avoided. Clinicians should use the minimal required dose of IVIg and slow the flow of perfusion (1-2 ml/kg/h).