title: Acute renal failure in a pediatric kidney allograft recipient treated with intravenous immunoglobulin for parvovirus B19 induced pure red cell aplasia.
abstract: Infection with parvovirus B19 (PV-B19) after solid organ transplantation may cause pure red cell aplasia (PRCA). Intravenous immunoglobulin (IVIg) may be of benefit in clearing the infection. Acute renal failure is a known adverse effect of IVIg administration. A 14-yr-old male received a cadaveric renal transplant. Three weeks after surgery he developed symptomatic anemia (hemoglobin 4.5 g/dL, reticulocyte count 0.2%). Anti-PV-B19 IgM and IgG titers, which had been negative pretransplant, were positive. He received two IVIg infusions as treatment for the PV-B19 infection. Four days after the IVIg infusions he developed non-oliguric acute renal failure (ARF) with a rise in serum creatinine from 1 to 1.8 mg/dL. Allograft biopsy showed changes consistent with an osmotic load. Anemia and the renal failure resolved after transfusions and IVIg. PV-B19 infection in immunosuppressed transplant recipients is associated with significant morbidity and may respond to IVIg therapy. High sucrose IVIg preparations may be associated with renal failure in renal allograft recipients. Adding PV-B19 testing of the donor and recipient to the standard pretransplant evaluation may be beneficial in diagnosing and managing a potential infection. If IVIg is to be used it may be safer to use a sucrose-free IVIg preparation.
authors.affiliation: Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY 10467, USA.
authors.forename: Mihail M
authors.initials: MM
authors.lastname: Subtirelu
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Flynn
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schechner
authors.forename: James M
authors.initials: JM
authors.lastname: Pullman
authors.forename: Dianne
authors.initials: D
authors.lastname: Feuerstein
authors.forename: Marcela
authors.initials: M
authors.lastname: Del Rio
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy*; D000293:Adolescent; D016731:Erythema Infectiosum / Q000150:complications / Q000276:immunology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D016732:Parvovirus B19, Human; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents