Renal infarction associated with low dose intravenous immunoglobulin in a kidney transplant recipient with sepsis: a case report and literature review

Abstract

Background: The use of human intravenous immunoglobulin gamma (IVIG) is associated with thromboembolic events as a complication. There are few reported cases of renal infarction during IVIG use in the general population, but transplant kidney may be more susceptible to thromboembolic events following IVIG use.

Case presentation: A 41-year-old woman visited with fever and pain at the transplant kidney. Six years ago, she underwent kidney transplantation from a deceased donor. Laboratory and radiologic findings were compatible to septic condition, secondary to acute pyelonephritis. We started antibiotics, inotropics, and IVIG. The patient abruptly developed gross hematuria and urine output decreased to 100 cc/day during IVIG administration. Renal doppler and pathologic findings revealed renal infarction. Oliguria and azotemia persisted and she is undergoing maintenance hemodialysis.

Conclusion: Our case shows that infarction of transplant kidney can be caused by IVIG use in a patient with severe infection. Thus, when using IVIG for kidney transplant patients with high risk of thromboembolic events, we may be careful to prevent the thromboembolic events.

Keywords: Intravenous immunoglobulin; Renal infarction; Thromboembolism.

Fig. 1

Changes in transplant kidney according to clinical courses. A At onset of acute pyelonephritis, peri-renal infiltration and fluid collection around transplant kidney in non-contrast image revealed acute pyelonephritis. B After 4 years of renal infarction, contrast image showed markedly atrophied transplant kidney (arrow head)

Fig. 2

Renal doppler and pathologic findings. A Flow signal at renal parenchyma was not detected in renal doppler. B Periodic acid-Schiff stain of the kidney showed coagulative necrosis with glomerular and tubular cells without discernible nuclei (× 400)