Pathologic and Laboratory Dynamics following the Removal of the Shunt in Shunt Nephritis

Abstract

Membranoproliferative glomerulonephritis (type 1) associated with infected ventriculoatrial shunt was observed in an 11-year-old girl. The removal of the shunt and antimicrobial therapy led to rapid improvement in the clinical symptoms, serologic abnormalities, and glomerular alterations. Serum complement levels were initially low and returned to normal values within 1 month. Urinary sediment abnormalities resolved within a few months. Cultures taken from cerebrospinal fluid and the end of the shunt grew Staphylococcus epidermidis. Initial renal biopsy obtained immediately before shunt removal showed membranoproliferative glomerulonephritis (type 1). Repeat biopsy performed 2 years after shunt removal showed moderate improvement of glomerular alterations. This study of pathologic and laboratory changes following therapy suggests that the pathophysiology of the nephritis was based on an immunologic process, and that removal of antigen resulted in reversal of glomerular changes.

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

“…Six biopsies had crescents [9, 19, 21, 53, 59, 64]. All the patients that had repeat biopsies after treatment of shunt nephritis demonstrated improvement in histologic findings [24, 28, 59, 60, 62, 63, 65]. One renal biopsy was initially read as amyloidosis but later retrospectively changed to “shunt nephritis” after signs and symptoms resolved with therapy [78].…”

Shunt nephritis associated with Moraxella bovis

“…Some authors advocate a trial of intensive antibiotic therapy, by systemic and intraventricular or intrashunt routes, as a first mode of treatment for shunt infections, prior to the surgical removal of the shunt apparatus (12,13). However, total shunt removal in combination with systemic antibiotic therapy is considered as the definitive treatment for shunt nephritis, usually associated with complete resolution of renal disease (1, 3,6,8,9).…”

American Society of Nephrology Clinical Pathological Conference

“…Subacute bacterial endocarditis and shunt nephritis with associated proliferative GN are rarely seen in children (6,7). When present, they occur in the specific context of a child with underlying cardiac disease or in the presence of cerebral ventricle-to-atrium shunt placement.…”