INTRAVENOUS IMMUNOGLOBULIN - INDUCED OSMOTIC NEPHROSIS

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.