Shunt Nephritis: A Report on Five Children

Zamora, I.; A, Lurbe; Alvarez-Garijo, A.; Mendizábal, Santiago; Simon, Judit

doi:10.1159/000120175

Cited by 7 publications

(9 citation statements)

References 3 publications

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“…Urinary protein, he maturia and urinary' casts decreased gradually, and disap peared within a few months. This favorable course after shunt removal is quite similar to the majority of cases reported [3], however, there are a few patients with chronic renal failure [6,7], Since Wegmann and Leuman's [8] description of 2 patients with this entity. 7 previously reported cases with repeat renal biopsy after the removal of the shunt [8][9][10][11][12] were found.…”

Section: Discussionsupporting

confidence: 81%

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

et al. 1993

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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.

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Section: Discussionsupporting

confidence: 81%

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

et al. 1993

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“…This further confirms the immune complex nature of the disease. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Of the 6 deaths that were reported, only 1 was conclusively attributed to renal failure [40], with the rest being unknown or secondary to surgical complications of hydrocephalus [7, 32, 49, 64]. It appears that immune suppression therapy does not attenuate this disease process and may even contribute to negative outcomes [31, 32, 34, 64].…”

Section: Discussionmentioning

confidence: 99%

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

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

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We present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevated serum creatinine, proteinuria, and new onset microhematuria. Blood and urine cultures were negative. Renal biopsy showed features of acute tubulointerstitial nephritis attributed to vancomycin use. Glomeruli showed increased mesangial hypercellularity and segmental endocapillary proliferation. Immunofluorescence showed focal IgM and C3 staining. Electron microscopy revealed small subendothelial electron-dense deposits. Symptoms and renal insufficiency appeared to improve with antibiotic therapy. He was discharged and readmitted 2 months later with similar presentation. CSF grew Propionibacterium acnes and shunt hardware grew coagulase-negative Staphylococcus. He completed an intravenous antibiotic course and was discharged. On 1-month follow-up, skin lesions persisted but he was otherwise asymptomatic. Follow-up labs showed significant improvement. We did a brief systematic review of the literature on shunt nephritis and report our findings on 79 individual cases. In this review, we comment on the presentation, lab findings, pathological features, and management of this rare, potentially fatal, but curable disease entity.

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“…Several intraoperative complications have been described for ventriculoatrial shunting [3 -6]. They are most commonly long-term infection, thrombosis, migration [7], glomerulonephritis [8], and others. We report a case of an endotracheal tube (ETT) cuff puncture due to a needle stick during ventriculoatrial shunt placement.…”

Section: Introductionmentioning

confidence: 99%