title: Hemoglobinuria and acute kidney injury requiring hemodialysis following intravenous immunoglobulin infusion.
abstract: Intravenous immunoglobulin (IVIG), a product initially developed for patients with immunodeficiencies, now has multiple other indications and increasing off-label use. IVIG generally is well tolerated, with few adverse effects. Antibody-mediated (Coombs-positive) hemolysis is known to occur after IVIG infusion, but often is subclinical and previously has not been reported to lead to acute kidney injury (AKI). The predominantly known mechanism of AKI after IVIG infusion has been osmotic nephrosis, primarily associated with sucrose-containing formulations. We present a case of a bone marrow transplant recipient who was treated with a sucrose-free IVIG product and subsequently developed Coombs-positive hemolysis leading to AKI requiring hemodialysis, who ultimately died secondary to infectious complications. The severity of this case emphasizes the importance of identifying populations who may be at increased risk of pigment-mediated kidney injury before consideration of IVIG therapy.
authors.affiliation: Division of Internal Medicine, Stanford University, Stanford, CA 94305-5114, USA.
authors.forename: Christine C
authors.initials: CC
authors.lastname: Welles
authors.forename: Shouieb
authors.initials: S
authors.lastname: Tambra
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lafayette
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000628:therapy; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000188:drug therapy; D006456:Hemoglobinuria / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors