Sucrose Nephropathy Following IV Immunoglobulin

Treatment with Intravenous Immunoglobulin (IVIg) has been found to be useful in patients with variety of diseases. IVIg infusions can produce allergic reactions. These adverse reactions are thought to be caused by activation of the complement cascade by the aggregation of IgG. To avoid this, a variety of stabilizing agents, including sucrose, are used. Sucrose is metabolized in the intestines by sucrase. If sucrose is given intravenously, this will be reabsorbed in to the proximal convoluted tubule and produce osmotic nephropathy which will present clinically as oliguric acute kidney injury. Patients with preexisting renal insufficiency, diabetes mellitus, elderly (>65 years), volume depletion and sepsis are more prone for these adverse effects and care should be taken not to use the IVIg with sucrose as a stabilizer in this population. If no other options are available, reductions in dose, concentration, and/or rate of administration of IVIg are warranted to reduce the incidence of renal failure. Pharmacist should be aware of the clinical scenario of the patient and choose the IVIg with appropriate stabilizer.