Ahsan N, Palmer B F, Wheeler D, Greenlee R G, Toto R D
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
Arch Intern Med. 1994 Sep 12;154(17):1985-7. doi: 10.1001/archinte.154.17.1985.
Intravenous immunoglobulin preparations are being used for an increasing number of indications in clinical medicine. To minimize adverse reactions, sugar additives such as sucrose are added to some preparations to serve as stabilizing agents. We describe a patient treated with an immunoglobulin preparation containing sucrose who developed a fully reversible form of acute renal failure with histologic changes characterized by vacuolization and swelling of renal proximal tubular cells. We believe the high concentration of sucrose in the immunoglobulin preparation resulted in osmotic injury to the renal tubules. Such changes, which are identical to those described in humans and experimental animals given intravenous infusions of hypertonic sucrose, have come to be known as osmotic nephrosis. Risk factors for the development of this lesion are renal insufficiency and volume depletion. The risk for such injury can be minimized by further diluting the immunoglobulin preparation and slowing the infusion rate.
静脉注射免疫球蛋白制剂在临床医学中的应用指征越来越多。为了尽量减少不良反应，一些制剂中添加了蔗糖等糖类添加剂作为稳定剂。我们描述了一名接受含蔗糖免疫球蛋白制剂治疗的患者，该患者出现了一种完全可逆的急性肾衰竭形式，其组织学改变的特征是肾近端小管细胞空泡化和肿胀。我们认为免疫球蛋白制剂中高浓度的蔗糖导致了肾小管的渗透性损伤。这种变化与静脉输注高渗蔗糖的人类和实验动物中所描述的变化相同，已被称为渗透性肾病。发生这种病变的危险因素是肾功能不全和容量耗竭。通过进一步稀释免疫球蛋白制剂并减慢输注速度，可以将这种损伤的风险降至最低。
