Acute Renal Failure Following use of Glycine- and Maltose-stabilized IVIG Preparations

Abstract

Background: Intravenous immunoglobulin (IVIG), used for immunodeficiency and autoimmune conditions, is generally well tolerated but may cause adverse effects such as acute kidney injury (AKI), especially with sucrose-containing formulations.Case Presentation: We present the case of an 83-year-old woman with myasthenia gravis who developed severe AKI following IVIG therapy with sucrose-free products. She was initially treated with glycine-stabilized KIOVIG, followed by maltose-stabilized GENIVIG.Results: Her serum creatinine increased from 0.70 to 3.78 mg/dL within days, requiring continuous venovenous hemodiafiltration (CVVHDF) for three weeks. The patient had no history of renal disease or exposure to nephrotoxic agents. Given the temporal relationship and absence of other causes, IVIG was identified as the likely contributor.Conclusion: This case highlights that sucrose-free IVIG preparations may carry a risk of significant nephrotoxicity, warranting close renal monitoring regardless of stabilizer type.