[PAGID] IVIG and acute renal failure

[Berger, Melvin]

Being clear that we have no data on subcu in this or other similar circumstances, I think the following two points are pertinent: 1. I would certainly change products. 2. Fractionating the dose is likely to diminish the load of any potential pernicious antibody or the protein poad in general. With those two points in mind I certainly think fractionating the dose of a different product would make this AE less likely, and sub-cu would facilitate giving smaller doses more often. 16% products, in turn, make the sub-cu administration easier.

 

Mel Berger

 

 

 

I have a newly dx'd 48 y/o CVID who had pre-existing chronic renal failure of unknown etiology and baseline creatinine of 3.1  We started IVIG using Gamunex to avoid the high sucrose/high osmolalityIVIG products.  Nevertheless, his creatinine increased to 5.1 for no other apparent reason. 


Since I don't know the mechanism by which this occurred, I don't know if it is related to the specific product or the dose.  Do people feel comfortable using weekly SQ infusions in this setting?  Any other thoughts?

Howard 
Howard M. Lederman, M.D., Ph.D. 
Professor of Pediatrics and Medicine 
Division of Pediatric Allergy and Immunology 
Johns Hopkins Hospital - CMSC 1102 
600 N. Wolfe Street 
Baltimore, MD 21287-3923 
Phone:  410-955-5883 
Fax:    410-955-0229 
e-mail: Hlederm1 at jhem.jhmi.edu 






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