[CIS PIDD] [cis-pidd] Renal Disease and CVID - IVIG replacement on haemodialysis (HD)

[CIS-PIDD]

Dear colleagues,

I posted a query a year ago concerning a  36 year-old lady with CVID who had several complications including bronchiectasis, massive splenomegaly and hypersplenism requiring splenectomy, and  liver disease with nodular regenerative hyperplasia. While receiving 3% sucrose IVIG replacement she developed renal impairment. Renal biopsy showed interstitial nephritis and she was switched to SC Beriglobin by "push" administration. Unfortunately her renal failure progressed and she has required HD. The problem is that we have not been able to get her serum IgG at the required trough level of 7-8 g/L (it's usually only 5 g/L) and she has had continued sinus infections, recently complicated by staphylococcal infection of the AV graft.

My questions are:


1.       Since she is on HD twice weekly, would there be any concern about reverting to 3% sucrose IVIG preparation which would permit higher doses of Ig replacement,  and a better chance of reaching required serum IgG level? (I guess the alternative would be to administer SC Ig via a pump to try for optimal levels).



2.       Are there any other considerations regarding the kinetics of IVIG in a patient on HD, any factors related to frequency of administration, catabolism of the product, etc? Presumably we would simple monitor the serum IgG weekly to determine dose and frequency of administration.



3.       Any other advice?


I would appreciate any input, suggestions, advice.

Thanks & Regards,

Stan

Stanley Ress
Emeritus Associate Professor of Medicine, UCT
Specialist physician & Clinical Immunologist
UCT Private Academic hospital,
Anzio Road, Observatory,
Cape Town, 7925
South Africa
TEL:INTERN<tel:INTERN>. + 2721-4421966 or 4421816
FAX:   "    + 2721-(0)865173095
Cell: 0833115482
email: stan.ress at uct.ac.za<mailto:stan.ress at uct.ac.za>




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