Orquera José David, Pernasetti María Marta, Ojeda Patricia, Agüero Griselda, Godoy Daniel Agustín
Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina.
Department of Nephrology, Sanatorio Pasteur, Catamarca, Argentina.
Bull Emerg Trauma. 2022 Jan;10(1):44-48. doi: 10.30476/BEAT.2021.85702.1103.
Immunoglobulin infusion (IVIG) is one of the first line therapy in Guillain Barre Syndrome (GBS). Several medical complications are associated with GBS (pneumonia, sepsis, deep vein thrombosis, dysautonomy). Acute kidney injury (AKI) is an uncommon complication during IVIG infusion. Several risk factors were associated with AKI during IVIG. These are an older age, previous renal disease, concomitant use of nephrotoxic agents, diabetes mellitus, hypovolemia, sepsis or using of IVIG that contained in its preparation sucrose or mannitol as stabilizers to avoid precipitation and aggregation. Infusion rate and total dose play a determinant role. The most important pathophysiological mechanism of AKI are the osmotic stress applied to the epithelium of proximal tubules and glomeruli. The osmotic overload is principally generated by IVIG stabilizers (sucrose). In general, AKI is reversible but approximately 30% hemodialysis is necessary. It is essential to respect doses, infusion rates and closely monitoring renal function parameters during IVIG infusion.
免疫球蛋白静脉输注（IVIG）是吉兰-巴雷综合征（GBS）的一线治疗方法之一。GBS会引发多种医学并发症（肺炎、败血症、深静脉血栓形成、自主神经功能障碍）。急性肾损伤（AKI）是IVIG输注过程中一种罕见的并发症。IVIG治疗期间，有几个危险因素与AKI相关。这些因素包括年龄较大、既往肾脏疾病、同时使用肾毒性药物、糖尿病、血容量不足、败血症或使用含有蔗糖或甘露醇作为稳定剂以避免沉淀和聚集的IVIG制剂。输注速率和总剂量起着决定性作用。AKI最重要的病理生理机制是近端肾小管和肾小球上皮受到的渗透压应激。渗透压过载主要由IVIG稳定剂（蔗糖）产生。一般来说，AKI是可逆的，但约30%的患者需要进行血液透析。在IVIG输注期间，必须遵守剂量、输注速率并密切监测肾功能参数。
