ACUTE-RENAL-FAILURE ASSOCIATED WITH IMMUNOGLOBULIN THERAPY

Four cases of acute renal failure induced by intravenous immunoglobuli n are presented, and the literature on the subject is reviewed. The cl inical course varies from asymptomatic serum creatinine elevation to a nuric renal failure occurring within days of the institution of therap y, followed by the rapid recovery of renal function after termination of therapy. The renal histology demonstrates severe tubular vacuolizat ion with cellular swelling and preservation of the brush border. Glome rular endothelial, mesangial, and epithelial cells also may demonstrat e swelling and vacuolization. There is no evidence for inflammatory or immune complex-mediated etiologies. The immunoglobulins or carbohydra te additives in the preparations appear to have a unique and reversibl e effect on the glomerular and tubular cell function. (C) 1995 by the National Kidney Foundation, Inc.