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Elevated creatinine in a patient on IVIG-therapy
Claire E Knezevic1, Mary Ann Ness1, Lisa E Kratz2
1Department of Pathology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
Summary
Proline in IVIG can falsely elevate creatinine levels, impacting patient monitoring. This interference is linked to the stabilizer and enzymatic assay mechanisms.
Area of Science:
- Clinical Chemistry
- Pharmacology
Background:
- Intravenous immunoglobulin (IVIG) is a critical therapy for various immune and inflammatory conditions.
- IVIG preparations utilize stabilizers like amino acids, which may affect laboratory test results.
Observation:
- A patient receiving IVIG for paraneoplastic syndrome showed an unexpected rise in creatinine levels.
- The elevated creatinine was attributed to the proline stabilizer present in the IVIG formulation.
Findings:
- Proline interferes with enzymatic creatinine assays, causing a positive bias.
- This interference is likely mediated by the sarcosine oxidase component of the assay reacting with proline.
Implications:
- Clinicians must be aware of proline interference in creatinine measurements during IVIG therapy.
- Understanding this interaction is crucial for accurate patient assessment and management, especially in cases of high-dose proline administration or metabolic disorders.
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