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Intravenous high-dose immunoglobulin therapy and glomerulopathies.
G Ital Nefrol. 2007 Jul-Aug;24(4):311-9.
Floccari F, Palla R, Polito P, Campo S, Aloisi C, Buemi M.
S.O.C. di Nefrologia e Dialisi, Ospedale San Giovanni Evangelista, Tivoli - Italy.
Intravenous
high-dose immunoglobulin (IVIG) therapy is used in several
antibody-mediated diseases including Guillain-Barré syndrome,
idiopathic thrombocytopenic purpura, and autoimmune neuropathies. In
the last decade, numerous studies have evaluated the application of
IVIG therapy in autoimmune glomerulopathies such as lupus nephritis,
membranous glomerulonephritis, and transplant-related chronic
nephropathy.
These studies were conducted on small numbers of patients
and varied with respect to IVIG doses and duration of therapy cycles.
Furthermore, many of the patients included in the studies did not
respond to conventional therapies, were affected by complications, and
had impaired renal function. IVIG therapy was able to reduce
proteinuria and inflammation and improve renal function in some forms
of glomerulonephritis, particularly LES-related forms. IVIG therapy was
also tested in patients awaiting kidney transplantation and in patients
affected by transplant-related chronic nephropathy: in both groups the
results were controversial. Seventy-eight cases of IVIG-related
nephrotoxicity have been reported in the literature. In most cases the
toxic effect was reversible and observed in patients with pre-existing
renal failure treated with IVIG formulations containing saccharose.
IVIG could have beneficial effects in many glomerulopathies.
Nevertheless, further trials are needed to clarify the potential and
the limitations of this therapeutic approach.
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