Intravenous immunoglobulin preparations are being used for an increasi
ng number of indications in clinical medicine. To minimize adverse rea
ctions, sugar additives such as sucrose are added to come preparations
to serve as stabilizing agents. We describe a patient treated with an
immunoglobulin preparation containing sucrose who developed a fully r
eversible form of acute renal failure with histologic changes characte
rized by vacuolization and swelling of renal proximal tubular cells. W
e believe the high concentration of sucrose in the immuno-globulin pre
paration resulted in osmotic injury to the renal tubules. Such changes
, which are identical to those described in humans and experimental an
imals given intravenous infusions of hypertonic sucrose, have come to
be known as osmotic nephrosis. Risk factors for the development of thi
s lesion are renal insufficiency and volume depletion. The risk for su
ch injury can be minimized by further diluting the immunoglobulin prep
aration and slowing the infusion rate.