ANKMJ
Ankyra Medical Journal

Ankyra Medical Journal (AnkMJ), formerly known as the Journal of Translational and Practical Medicine, regularly publishes international quality issues in the field of Medicine in the light of current information.

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Original Article
Assessing the impact of non-sucrose IVIG preparations on urinary NGAL levels
Abstract
Aims: The study aimed to show whether non-sucrose-containing intravenous immunoglobulin (IVIG) administration affected urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels within 24 hours and whether the uNGAL elevations preceded the development of acute kidney injury (AKI).
Methods: The study included 20 patients who received IVIG treatment in Internal Medicine and Neurology clinics between January 2022 and September 2022 and 10 controls (2:1 ratio) with similar age, gender, and comorbidity who did not receive IVIG. The uNGAL levels were classified as elevated (>80 ng/mL) or normal (<80 ng/mL). Patients were monitored for at least 48 hours, up to a maximum of 7 days, or until discharged, to assess the development of AKI.
Results: None of the patients developed AKI during the follow-up period. Posttreatment median uNGAL levels were 7.1 ng/mL (3.35-37.45 ng/mL, p=0.37, Wilcoxon sign-rank test), similar to pretreatment levels. However, when compared categorically, only two patients (10%) had uNGAL levels higher than 80 ng/mL pretreatment, which increased to four patients (20%) posttreatment (p=0.032, Fisher’s exact test).
Conclusion: In our small-scale study, although acute kidney injury did not develop after IVIG treatment, the increased percentage of patients (increases from %10% to 20) with elevated uNGAL levels suggests that acute kidney injury may develop even in formulations that do not contain sucrose as a stabilizer.

Keywords : Acute kidney injury, biomarkers, intravenous immunoglobulin, neutrophil gelatinase-associated lipocalin

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1. Barandun S, Kistler P, Jeunet F, Isliker H. Intravenous administration of human gamma-globulin. Vox Sang. 1962;7(2):157-174.
2. Perez EE, Orange JS, Bonilla F, et al. Update on the use of immunoglobulin in human disease: a review of evidence. J Allergy Clin Immunol. 2017;139(3S):S1-S46.
3. Farrugia A, Grazzini G, Quinti I, Candura F, Profili S, Liumbruno GM. The growing importance of achieving national self-sufficiency in immunoglobulin in Italy. The emergence of a national imperative. Blood Transfus. 2019;17(6):449-458.
4. Jo&atilde;o C, Negi VS, Kazatchkine MD, Bayry J, Kaveri SV. Passive serum therapy to immunomodulation by IVIG: a fascinating journey of antibodies. J Immunol. 2018;200(6):1957-1963.
5. Palabrica FR, Kwong SL, Padua FR. Adverse events of intravenous immunoglobulin infusions: a ten-year retrospective study. Asia Pac Allergy. 2013;3(4):249-256.
6. Dantal J. Intravenous immunoglobulins: in-depth review of excipients and acute kidney injury risk. Am J Nephrol. 2013;38(4):275-284.
7. Bellomo R, See EJ. Novel renal biomarkers of acute kidney injury and their implications. Intern Med J. 2021;51(3):316-318.
8. Konukoğlu D. Biomarkers for acute kidney injury. Int J Med Biochem. 2018;1(2):80-87.
9. Vaidya VS, Ferguson MA, Bonventre JV. Biomarkers of acute kidney injury. Annu Rev Pharmacol Toxicol. 2008;48(1):463-493.
10. Tecson KM, Erhardtsen E, Eriksen PM, et al. Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults: retrospective determination and clinical validation of a prospective multicentre study. BMJ Open. 2017;7(7):e016028.
11. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-184.
12. Goldstein SL, Akcan-Arikan A, Afonso N, et al. Derivation and validation of an optimal neutrophil gelatinase-associated lipocalin cutoff to predict stage 2/3 acute kidney injury (AKI) in critically ill children. Kidney Int Rep. 2024;9(8):2443-2452.
13. Puthumana J, Lugon NC, Xu Y, et al. Systematic review and meta-analysis of urine neutrophil gelatinase-associated lipocalin for acute kidney injury in cirrhosis. Kidney Int Rep. 2024;9(7):2278-2281.
14. Jefferies JL, Kovesdy CP, Ronco C. Contemporary laboratory assessment of acute cardiorenal syndrome for early diagnosis: a call for action. Am Heart J. 2023;261:75-84.
15. Bolignano D, Coppolino G, Campo S, et al. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is associated with severity of renal disease in proteinuric patients. Nephrol Dial Transplant. 2008; 23(1):414-416.
16. Lacquaniti A, Donato V, Pintaudi B, et al. &quot;Normoalbuminuric&quot; diabetic nephropathy: tubular damage and NGAL. Acta Diabetol. 2013;50(6): 935-942.
17. Bolignano D, Lacquaniti A, Coppolino G, et al. Neutrophil gelatinase-associated lipocalin as an early biomarker of nephropathy in diabetic patients. Kidney Blood Press Res. 2009;32(2):91-98.
18. Duan S, Chen J, Wu L, et al. Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease. J Diabetes Complications. 2020;34(10):107665.
19. Şen S, &Ouml;zalp Kızılay D, Taneli F, et al. Urinary NGAL is a potential biomarker for early renal injury in insulin resistant obese non-diabetic children. J Clin Res Pediatr Endocrinol. 2021;13(4):400-407.
20. Nielsen SE, Andersen S, Zdunek D, Hess G, Parving HH, Rossing P. Tubular markers do not predict the decline in glomerular filtration rate in type 1 diabetic patients with overt nephropathy. Kidney Int. 2011; 79(10):1113-1118.
Article available in :
Volume 4, Issue 1, 2025
Page : 1-4
https://doi.org/10.51271/ANKMJ-0035
Article Information
Received : 15 Kas 2024
Accepted : 22 Ara 2024
Published : 06 Oca 2025
Corresponding Author :

Gökhan Tazegül: Department of Internal Medicine, Faculty of Medicine, Marmara University, İstanbul, Turkiye

[email protected]
Citation : Karataş HK, Tazegül G, Çınar N, Yeğenağa I. Assessing the impact of non-sucrose IVIG preparations on urinary NGAL levels. Ank Med J. 2025;4(1):1-4.

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