100457 - Use of subcutaneous human immunoglobulin in patients with hypogammaglobulinemia secondary to nephrotic syndrome in a tertiary pediatric hospital

Nephrotic syndrome (NS) is an important cause of secondary hypogammaglobulinemia, leading to critical values of immunoglobulin G (IgG) serum levels (<200 mg/dL). One of the possible therapeutic approach is the subcutaneous immunoglobulin replacement (IGSC) therapy. This replacement aims to reduce infectious conditions, as well as complications resulting from relapses and, consequently, improve quality of life. 

Descriptive and analytical observational study, with a longitudinal de- sign, carried out in a tertiary hospital in the Federal District (DF) in Brazil composed of patients in the pediatric age group with diagnosis of hypogammaglobulinemia secondary to NS. 

In total, 19 patients aged between 1 and 17 years had their IgG levels pre- and post-IGSC evaluated. Most patients had resolution of IgG levels considered critical. After 12 months of IGSC replacement, 93.3% of patients had IgG > 200 mg/dL and most of children (66.7%) had serum IgG above 400 mg/dL in the same time period. The evaluation of the variable: IgG/albumin ratio shows that, even during the relapses of NS, IgG levels pos-IGSC were higher than the period pre-IGSC. There was no positive correlation between IGSC replacement and number of infections, antibiotic time and hospitalization.

Regular replacement therapy of IGSC in the study population resulted in a significant increase in serum IgG levels, but also in the variable IgG/albumin during the study period. Length of hospital stay and use of antibiotics were not influenced by IGSC therapy. The present report describes benefits of IGSC in children with NS and hypogammaglobulinemia. A larger cohort would provide more data.