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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
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.
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:
- 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.