Wajanaponsan Non, Cheng Shiuh-Feng
Hawaii Med J. 2004 Sep;63(9):266-7.
Intravenous administration of immunoglobulin is used for the treatment of many conditions, including primary immunodeficiency states, autoimmune disorders, glomerulonephritides and polyneuropathy. Acute renal failure induced by intravenous immunoglobulin is a known but rare adverse reaction. We have a patient who was treated with IVIG for inflammatory polyneuropathy. Intravenous immunoglobulin therapy 0.5 g/kg/ d was given for 4 days. Three days after completion of IVIG therapy, patient developed decreased urine output. His serum creatinine increased from baseline of 1.3 to 7 mg/dL. Even though IVIG was discontinued, patient required hemodialysis. This case illustrated that IVIG can cause acute oliguric renal failure which is reversible after withdrawal of the drug. Risk factors include pretreatment renal impairment, diabetes mellitus, high concentration of sucrose or glucose in IVIG preparation and older age. Awareness of this serious side effects and recognition of predisposing factors provide means of avoiding a known life threatening complication of IVIG therapy.
静脉注射免疫球蛋白可用于治疗多种病症，包括原发性免疫缺陷状态、自身免疫性疾病、肾小球肾炎和多发性神经病。静脉注射免疫球蛋白引起的急性肾衰竭是一种已知但罕见的不良反应。我们有一名因炎性多发性神经病接受静脉注射免疫球蛋白治疗的患者。给予静脉注射免疫球蛋白治疗，剂量为0.5 g/kg/天，持续4天。静脉注射免疫球蛋白治疗结束后三天，患者尿量减少。他的血清肌酐从基线值1.3 mg/dL升至7 mg/dL。尽管停用了静脉注射免疫球蛋白，但患者仍需要进行血液透析。该病例表明，静脉注射免疫球蛋白可导致急性少尿性肾衰竭，停药后可逆转。危险因素包括治疗前肾功能损害、糖尿病、静脉注射免疫球蛋白制剂中蔗糖或葡萄糖浓度高以及年龄较大。认识到这种严重副作用并识别易感因素，为避免静脉注射免疫球蛋白治疗已知的危及生命的并发症提供了方法。
