Intravenous Immunoglobulin Nephrotoxicity
DOI:
https://doi.org/10.3166/rea-2018-0059Keywords:
High-flow nasal cannula, Pulmonary embolism, Respiratory acidosis, Positive end expiratory pressure, Respiratory dead space, Acute right heart failureAbstract
Intravenous immunoglobulin (IVIG) indications have been dramatically increased recently in many medical fields as antibody replacement therapy at low-dose or for immunomodulatory purposes at high-dose (1–2 g/kg). IVIG contains the pooled immunoglobulins from the plasma of approximately a thousand or more blood donors and its nephrotoxicity has been described since the 1990s and mainly attributed to sucrose stabilizers. Histological analysis of the kidneys showed osmotic nephrosis lesions with tubular vacuolization and acute tubular necrosis. From the mid-2000s forward, some new IVIG formulations without sucrose have been used to decrease acute kidney injury (AKI) incidence. These formulations should be preferred in patients at risk of AKI including old patients, diabetes mellitus, obese, hypovolemic or with a chronic kidney disease or a renal graft.
