[CIS PIDD] ScIg & REnal impairment

[Richard Wasserman]

Jason,
A couple of thoughts. How many times has this association be observed? Note
that he peak IgG concentration following subq administration is day 3. As
you say, it is hard to imagine a mechanism. You could try daily push if
there is truly a concern.
Richard Wasserman,
Dallas

On Fri, Sep 14, 2012 at 2:34 PM, <raas0027 at umn.edu> wrote:


>

> Quick question:

>

> Has anyone noted impaired kidney function (using increased serum

> creatinine as a 'marker') with subcutaneous immunoglobulin?

>

>

> Background:

>

> I have a patient that I care for who lives a few hundred miles from our

> clinic. Older gentleman, complex medical history including CVID, lymphoma,

> chemotherapy, heart disease. Has had a creatinine above 1.2 and as high as

> 2.4 for a few years (before ScIg).

>

> He calls reporting a temporal relationship (increase in creatinine) with

> Hizentra administration (e.g. administers ScIg one day, creatinine goes from

> 1.2 to up to above 2.0 the next day).

>

> I cannot conceive of a mechanism for why this might occur with

> SUBCUTANEOUS IgG (IVIG, yes; ScIg, no). His other specialists are convinced

> its the ScIg and advising him to discontinue. (?!)

>

> I performed a literature search and found no case reports.

> I am very dubious of the proposed CAUSAL relationship but before I take

> such a stance I would like your observations about this.

>

> Thanks.

>

> -J

>

> P.S. Thanks to all regarding your comments about primary immune deficiency

> and alpha-1 antitrypsin deficiency.

>

>

>

> --

> Jason Raasch, MD

>

> Midwest Immunology Clinic

> 15700 37th Ave N

> Suite 110

> Plymouth, MN 55446

>

> (Phone) 763.577.0008

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>




-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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