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Related Experiment Videos

Intravenous immunoglobulin-induced osmotic nephrosis

N Ahsan1, B F Palmer, D Wheeler

  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

Archives of Internal Medicine
|September 12, 1994
PubMed
Summary

High-dose sucrose in intravenous immunoglobulin preparations can cause acute kidney injury, known as osmotic nephrosis. Diluting the preparation and slowing infusion can minimize this risk in patients with renal insufficiency.

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Area of Science:

  • Nephrology
  • Pharmacology

Background:

  • Intravenous immunoglobulin (IVIG) preparations are increasingly used for various medical indications.
  • Sucrose is added to some IVIG products as a stabilizing agent to minimize adverse reactions.

Observation:

  • A patient receiving an IVIG preparation containing sucrose developed acute renal failure.
  • Histologic examination revealed vacuolization and swelling of renal proximal tubular cells.

Findings:

  • The observed renal injury, termed osmotic nephrosis, is attributed to the high concentration of sucrose causing osmotic injury to renal tubules.
  • This condition is identical to previously described cases of intravenous hypertonic sucrose infusions in humans and animals.

Implications:

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  • Patients with pre-existing renal insufficiency and volume depletion are at higher risk for developing sucrose-induced osmotic nephrosis.
  • Diluting IVIG preparations and reducing infusion rates can mitigate the risk of this adverse renal event.