Shunt Nephritis: A Rare and Forgotten Diagnosis

Abstract

Shunt nephritis is a rare complication of ventriculoatrial and ventriculoperitoneal shunt infection. The clinical manifestations are nonspecific and include asthenia, arthralgias, anorexia, weight loss, hematuria, proteinuria, and progressive renal impairment. Therefore, diagnosis can be delayed up for to several years after the first clinical manifestations, which increases the risk of progressive renal impairment and neurological dysfunction. A 57-year-old woman who had undergone ventriculoperitoneal shunt placement in 1990 was admitted to the nephrology department to perform an elective kidney biopsy due to hematuria, proteinuria, and rapidly progressive renal failure. The patient presented with asthenia and weight loss with a duration of one year. No other symptoms were reported. The kidney biopsy was suggestive of infection associated glomerulonephritis, particularly a subacute infection, as a membranoproliferative pattern was seen in light microscopy, and IgM staining was predominant in immunofluorescence imaging. During the hospital stay, the patient developed neurological symptoms. Cerebrospinal fluid examination showed pleocytosis. Shunt nephritis was suspected, and antibiotic treatment was initiated. Due to the patient’s worsening neurological status, an urgent surgical shunt removal was performed. Two months later, her renal function was normal, and the urinalysis result was unremarkable, even though her neurological status did not improve. Although rare, shunt nephritis should be considered in patients that have a history of ventriculoperitoneal shunt placement and present with a proliferative or membranoproliferative glomerulonephritis and prominent IgM deposits in immunofluorescence imaging. Early diagnosis and shunt removal are critical for improving the neurological and renal prognosis.