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reactions to IGG

  My mther has been diagnosed with CIDP, and just finished her second week of IGG treatment. Before the latest series was over, she quit producing urine, and is now in acute renal failure with alot of fluid retention. Are these problems possibly a reaction to the IGG? If so, should she discontinue treatments? She had responded so well to the first series.
Dear Ron:
Acute renal failure from acute tubular necrosis is an uncommon but well-recognised complication of IVIg. It results from impaired renal perfusion resulting from the hyperviscous and hyperosmaolar state of the blood caused by IVIg. The risk is higher in pre-existing renal disease from diabetes etc. Recovery of renal function is usually good. The risk of renal failure can be diminished by adequate hydration, and by lower daily doses of IVIg (eg 400mg/kg/d X 5d as against 1g/kg/d X 2d).
The decision of receiving more IVIg treatments or of choosing probably equally effective alternatives such as plasma exchange will have to be taken by your mother and you in consultation with her neurologist and nephrologist

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