Can IVIG cause kidney failure? Understanding the risks and prevention

October 13, 2025 •

3 min read

Although intravenous immunoglobulin (IVIG) is a vital treatment for numerous conditions, reports dating back to the late 1990s documented that it can cause acute renal failure. This serious but rare side effect highlights the importance of understanding the potential kidney risks associated with IVIG therapy.

Quick Summary

Intravenous immunoglobulin can cause acute kidney injury, particularly in high-risk patients receiving sucrose-stabilized formulations. Risks are mitigated by using non-sucrose alternatives, proper hydration, and monitoring kidney function before and after infusion.

Key Points

Rare but Possible: IVIG can cause acute kidney injury (AKI), although it is a rare complication.
Sucrose is a Key Factor: Historically, older, sucrose-stabilized IVIG formulations were a primary cause of osmotic nephrosis, a form of tubular injury.
Risk Factors Identify Vulnerable Patients: High-risk individuals include the elderly, those with pre-existing kidney disease, diabetes, or dehydration.
Prevention is Crucial: Strategies like adequate hydration, slower infusion rates, and using sucrose-free products can minimize risk.
SCIG is a Safer Alternative: Subcutaneous immunoglobulin (SCIG) is not associated with kidney toxicity and is an option for high-risk patients.
Monitoring is Essential: Baseline and ongoing monitoring of kidney function are vital for early detection and management.
Kidney Injury is Often Reversible: Most cases of IVIG-related acute kidney injury resolve after discontinuing the medication and providing supportive care.

What is intravenous immunoglobulin (IVIG)?

Intravenous immunoglobulin (IVIG) is a therapeutic product derived from pooled human plasma, containing a broad spectrum of IgG antibodies. It is used to treat various conditions, including immune deficiencies and autoimmune disorders, by modulating the immune system. While effective, IVIG carries potential risks, including a rare but serious effect on kidney function.

Can IVIG cause kidney failure?

Yes, IVIG can cause kidney failure, specifically acute kidney injury (AKI), although it is a rare adverse event, typically occurring within days of starting therapy. While often reversible with supportive care, severe outcomes like chronic kidney disease, end-stage renal disease, and death have been reported. The risk is influenced by patient factors and the specific IVIG formulation used.

The mechanism of IVIG-induced nephrotoxicity

Historically, the main cause of IVIG-induced kidney injury was the excipient (stabilizing agent) sucrose, present in certain formulations.

Sucrose-induced osmotic nephrosis

Sucrose was used to prevent IgG aggregation, but kidneys lack the enzyme sucrase to metabolize it. High doses lead to sucrose reabsorption in the proximal tubules, causing hyperosmolar stress, cell swelling, vacuolization, and tubular damage. Due to reported renal adverse effects, many sucrose-containing IVIG products have been discontinued or are used cautiously in at-risk patients.

Mechanisms with non-sucrose formulations

AKI can still occur with non-sucrose IVIG, possibly due to hyperviscosity from rapid infusion, impaired renal blood flow, or immune complex formation in renal tubules. Renal vasoconstriction may also play a role.

Identifying and managing risk factors

Patient factors significantly impact the risk of IVIG-induced kidney injury. Screening and management are crucial for those at higher risk.

Major risk factors

Factors increasing risk include advanced age (over 65), pre-existing kidney disease, diabetes mellitus, dehydration, high dose and rapid infusion, and concurrent use of other nephrotoxic drugs.

Monitoring and prevention

To minimize kidney problems, clinicians follow monitoring protocols. This includes checking renal function (serum creatinine, eGFR) before therapy, ensuring adequate hydration, adjusting dose and infusion rate, regular monitoring for high-risk patients, and using sucrose-free IVIG or subcutaneous immunoglobulin (SCIG) when possible.

IVIG vs. SCIG: A comparison for kidney health

For patients with kidney risk factors, the administration method of immunoglobulin therapy is important. SCIG offers a notable advantage regarding renal safety.


Feature	Intravenous Immunoglobulin (IVIG)	Subcutaneous Immunoglobulin (SCIG)
Administration	Infused directly into a vein.	Injected into the subcutaneous tissue (under the skin).
Volume	Large volume of fluid infused over a few hours.	Much smaller volume infused over a longer, sustained period.
Excipients	Formulations may contain various stabilizers, historically including sucrose, which caused renal toxicity.	Does not contain sucrose and has a much lower infused quantity.
Renal Risk	Rare but documented risk of acute kidney injury and renal failure, especially in high-risk patients and with certain formulations.	No reported cases of kidney toxicity to date, making it a safer option for patients with renal concerns.
Infusion Rate	Administered relatively quickly, especially at high doses, which increases renal stress.	Slow, controlled infusion rate over many hours or days, reducing systemic burden.
Setting	Typically administered in a hospital or clinic setting due to the size of the infusion.	Can be self-administered at home after proper training, offering greater convenience.

What to do if kidney problems occur

If kidney dysfunction is suspected after IVIG, immediate steps include discontinuing IVIG, providing supportive care (including potential temporary hemodialysis in severe cases), and managing complications. Most AKI cases are reversible, with kidney function recovering within days or weeks.

Conclusion

While IVIG is a vital therapy, it carries a known risk of kidney failure, particularly AKI. Sucrose-containing formulations were historically the main cause of osmotic nephrosis, though non-sucrose formulations also pose a risk. Minimizing risk involves careful patient selection, monitoring renal function, adequate hydration, using lower doses and slower infusion rates, and avoiding other nephrotoxic drugs. Sucrose-free IVIG and SCIG are alternatives for high-risk individuals. Vigilance helps protect kidney health while providing this essential treatment. For further details on clinical management, refer to resources like the American Journal of Health-System Pharmacy.

Frequently Asked Questions

While the risk is historically highest with sucrose-stabilized IVIG formulations, which caused osmotic nephrosis, rare cases of acute kidney injury have also occurred with non-sucrose formulations. As a result, all IVIG products carry a risk, especially in high-risk patients.

Osmotic nephrosis is a form of kidney tubular injury caused by an osmotic overload. In the case of IVIG, it occurred primarily with older formulations that contained sucrose as a stabilizer. Since the kidneys cannot metabolize sucrose, it accumulates in the proximal tubules, causing osmotic stress and damage to the tubular cells.

Patients at the highest risk include those over 65 years old, individuals with pre-existing kidney disease, diabetes mellitus, dehydration, and those receiving high IVIG doses or other nephrotoxic medications.

Signs of IVIG-induced kidney problems include a rise in serum creatinine, a decrease in estimated glomerular filtration rate (eGFR), mild-to-moderate proteinuria, hematuria, and edema. These signs typically appear within 1 to 10 days of infusion.

Yes, most cases of acute kidney injury caused by IVIG are reversible with prompt discontinuation of the drug and supportive care. Renal function typically returns to baseline within days or weeks, though severe cases may require temporary dialysis.

Preventive measures include using sucrose-free IVIG formulations, ensuring adequate hydration before and during infusion, administering the lowest effective dose, and infusing at a slower rate. Patient screening for risk factors and monitoring kidney function are also essential.

For patients with risk factors for kidney issues, subcutaneous immunoglobulin (SCIG) is a safe and effective alternative. SCIg involves lower, more frequent dosing that is less taxing on the kidneys and has not been associated with kidney toxicity.