Intravenous immunoglobulin induced-nephropathy: a complication of IVIG therapy

Since the early 1950s, intravenous immunoglobulin (IVIG) preparations are being used in the treatment of hematologic, neurologic, nephrologic, autoimmune, and immunodeficiency disorders. Infusion of IVIG preparations may cause osmotic-induced acute renal failure. Despite the fact that this entity has been reported previously, it is not a widely appreciated complication. A total of 22 reports involving 52 patients in whom renal failure occurred in association with IVIG infusion. The patients' ages ranged from 20 to 82 years. Thirty patients had preexisting renal insufficiency. Rise in serum creatinine was noted after 1-10 days of IVIG infusion and creatinine returned to baseline within 2-60 days of discontinuation. One developed end stage renal disease. There were four fatalities related to complications of renal failure. Histopathology of renal tissue showed osmotically induced tubular injury (5 patients), tubular vacuolization (2 patients), tubulointerstitial infiltrate (1 patient), and cryoglobulin deposits (1 patient). There appears to be no direct relationship between the development of acute renal failure and the type of IVIG. However, underlying renal insufficiency increases the risk of renal failure. In view of the increasing use of IVIG preparations in medicine, it is imperative that clinicians be aware of this unusual form renal injury.