title: Case report: thrombotic microangiopathy post-intravenous immunoglobulin in the context of BK nephropathy and renal transplantation.
abstract: Intravenous immunoglobulin (IVIg) is a blood product with immunomodulating properties that have been widely applied in the management of renal transplant recipients. In general, IVIg has been considered a relatively safe therapy, with most adverse events being mild and transient. Although rare, a serious and well-recognized complication of IVIg is large-vessel thrombotic events, which are thought to be related to hyperviscosity. We describe here two cases in which there was a temporal relationships between the administration of IVIg, an acute decline in allograft function, and the histologic finding of de novo thrombotic microangiopathy (TMA). In both cases, IVIg had been administered to facilitate immunosuppressive dose reduction in the context of BK nephropathy. We believe this is the first report of TMA associated with IVIg administration in renal allograft recipients.
authors: Department of Nephrology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
authors: F F
authors: FF
authors: Pan
authors: Department of Nephrology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
authors: L
authors: L
authors: Hidayati
authors: Department of Nephrology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia.
authors: P
authors: P
authors: Hughes
authors: Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
authors: A
authors: A
authors: Murugasu
authors: Department of Nephrology, Royal Melbourne Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia. Electronic address: Rosemary.masterson@mh.org.au.
authors: R
authors: R
authors: Masterson
mesh_terms: D064591:Allografts; D001739:BK Virus; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000601:surgery; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000150:complications*; D051437:Renal Insufficiency / Q000601:surgery*; D013927:Thrombosis; D057049:Thrombotic Microangiopathies / Q000139:chemically induced*
chemical_list: D016756:Immunoglobulins, Intravenous