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

[CIS-PIDD]

Dear Stan,
I would definitely go for SCIG (and be prepared to combine weekly scig +
monthly ivig if the desired levels are not achieved). I would recheck
intestinal losses are not present.
Hope this helps
Nacho

*Luis I. Gonzalez-Granado. MD.*Immunodeficiencies Unit. Hospital 12 de
octubre.
Research Institute Hospital 12 octubre (i+12)
Av. Cordoba S/N. 28041. Madrid. Spain
Tel. *0034**606732959 / * 0034913908569  /  Fax 0034913908772
<0034934893039>luisignacio.gonzalez at salud.madrid.org
<luisignacio.hdoc at salud.madrid.org>ORCID ID:  orcid.org/0000-0001-6917-8980
Researcher ID: B-9257-2009ResearchGate:
https://www.researchgate.net/profile/Luis_Gonzalez-Granado LinkedIn:
https://es.linkedin.com/in/nachgonzalez

2016-04-21 12:02 GMT+02:00 CIS-PIDD <cis-pidd at lists.clinimmsoc.org>:

> 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 <INTERN>. + 2721-4421966 or 4421816
> FAX:   "    + 2721-(0)865173095
> Cell: 0833115482
>
> email: stan.ress at uct.ac.za
>
>
>
>
>
>
>
>
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