Renal failure after anti-D globulin treatment of idiopathic thrombocytopenic purpura

被引:19
作者
Kees-Folts, D
Abt, AB
Domen, RE
Freiberg, AS
机构
[1] Penn State Univ, Milton S Hershey Med Ctr, Dept Pediat, Hershey, PA 17033 USA
[2] Penn State Univ, Penn State Childrens Hosp, Coll Med, Hershey, PA 17033 USA
[3] Penn State Univ, Milton S Hershey Med Ctr, Coll Med, Dept Pathol, Hershey, PA 17033 USA
关键词
acute renal failure; idiopathic thrombocytopenic purpura; anti-D globulin; intravascular hemolysis; hemoglobinuria; pigment nephropathy;
D O I
10.1007/s00467-001-0763-4
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Idiopathic thrombocytopenic purpura (ITP) is a disorder of rapid destruction of antibody-coated platelets. Anti-D immune globulin has been used for treatment of ITP in the United States since 1995. Initial studies identified no significant side effects of treatment. However, a recent report highlighted occasional episodes of intravascular hemolysis after anti-D immune globulin. We describe two children with ITP who developed acute renal failure (ARF) after treatment with anti-D immune globulin and also analyze ten additional cases of ARF reported to the manufacturer, Cangene Corporation, through postmarketing surveillance. All episodes of ARF were associated with intravascular hemolysis. Four patients required dialysis. Patient age ranged from 1 to 82 years, but those requiring dialysis were all under age 15 years. Several patients with ARF had preexisting creatinine elevation. Three of the patients with ARF had serologic evidence of acute Epstein-Barr virus (EBV) infection. Renal biopsy in one patient showed acute tubular necrosis, with findings consistent with pigment nephropathy. Anti-D immune globulin, used to treat ITP, may be associated with intravascular hemolysis and resultant ARF. Renal function should be monitored in patients with evidence of intravascular hemolysis. Children and adolescents may have increased risk of ARF requiring dialysis.
引用
收藏
页码:91 / 96
页数:6
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