Acute renal failure related to intravenous immunoglobulin infusion in an elderly woman

TH Kwan, MKH Tong, YP Siu, KT Leung, HK Lee, CY Yung, TC Au
Division of Nephrology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong

Intravenous immunoglobulin infusion induces acute renal failure via a mechanism of osmotic nephrosis. Most reported cases are related to the use of sucrose-based intravenous immunoglobulin. Maltose-based intravenous immunoglobulin is thought to be a safer alternative and have a lower risk of renal toxicity than sucrose-based preparations. Maltase, but not sucrase, is present in the brush border of proximal convoluted renal tubules, where the maltose is metabolised. We report a case of maltose-based intravenous immunoglobulin–induced acute renal failure in an elderly diabetic woman. In this case, the risk factors included advanced age, hypovolaemia, sepsis, diabetes mellitus, and the high infusion rate of the intravenous immunoglobulin. Maltase is readily inhibited by hyperglycaemia; therefore, poor glycaemic control may predispose patients to develop acute renal failure even with the better-tolerated maltose-based intravenous immunoglobulin.

Hong Kong Med J 2005;11:45-9

Key words: Immunoglobulins, intravenous; Kidney failure, acute; Maltose; Sucrose