Shunt nephritis from Propionibacterium acnes in a solitary kidney

Balogun, Rasheed A.; Palmisano, Joseph; Kaplan, André A.; Khurshid, Humera; Yamase, Harold; Adams, Nancy D.

doi:10.1053/ajkd.2001.27726

Cited by 12 publications

(6 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The pathogenetic mechanism of shunt nephritis is not clear. It is hypothesized that the hydrophobic shunt material, acting as a nidus of infection, coupled with biofilm produced by bacteria promotes bacterial growth and bacteremia [ 10 ]. The released bacterial antigen results in formation of circulating immune complexes [ 66 , 67 ], which are deposited in the glomeruli and activate the complement system [ 29 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

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

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

View full text Add to dashboard Cite

show abstract

“…Shunt nephritis is a rare complication of shunt infection, and renal injury results from persistent antigenemia due to chronic bacteremia, subsequent immune complex glomerular deposition, classical pathway complement activation, and direct injury to glomerular cells. This is supported by a high frequency of circulating immunocomplexes, cryoglobulinemia, and rheumatoid factor, as well as the preferential localization of deposits in the mesangium and sub-endothelial region (8,11,12). Usually, shunt nephritis occurs at six months after shunt placement.…”

Section: Discussionmentioning

confidence: 99%

Shunt Nephritis: A Rare and Forgotten Diagnosis

Reis¹,

Gomes²,

Furtado³

et al. 2021

J Nephropathol

View full text Add to dashboard Cite

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.

show abstract

“…As manifestações clínicas habitualmente encontradas são hematúria (89%), febre recorrente (88%), hepatoesplenomegalia (55%), púrpura não trombocitopénica (19%) e hipertensão arterial (15%) 9 . Oitenta e seis porcento dos doentes A semelhança do que acontece em outras situações de bacteriemias associadas a dispositivos intravasculares, na infeção de shunt há indicação para a remoção do mesmo; no nosso caso fez-se uma tentativa inicial de erradicação do microrganismo com antibiótico, dado o historial prévio da tentativa de remoção, sem sucesso, o que faria prever uma cirurgia complicada, morosa e de alto risco.…”

Section: Discussionunclassified

Um caso de Nefrite de shunt associada a elevação transitória de anticorpos anti-dsDNA

Soares¹,

Rosário²,

Silva³

et al. 2014

Gal. Clin.

View full text Add to dashboard Cite

ResumoA relação entre doenças autoimunes e infeção está bem descrita na literatura. No entanto, desconhece-se qual o mecanismo patofisiológico envolvido nas infeções para o desenvolvimento de autoimunidade. Por outro lado, existem infeções que cursam transitoriamente com positividade para alguns autoanticorpos sem nenhuma evidência de doença imunológica.A nefrite de shunt (NS) é uma glomerulonefrite mediada por imunocomplexos que surge habitualmente associada a infeção de shunt ventrículo-auricular. Raramente, a NS pode-se acompanhar de marcadores imunológicos positivos como os anticorpos antinucleares e anti-citoplasma dos neutrófilos (ANCA). Contrariamente, os anticorpos anti-DNA de cadeia dupla (anti-dsDNA) são reconhecidos pela sua especificidade para o diagnóstico de lúpus e desconhecem-se relatos prévios da sua associação a NS.Os autores apresentam o caso de uma NS com positividade tanto para os ANCA-PR3 como para os anti-dsDNA em que não houve manifestação de doença autoimune e em que a resolução da infeção levou à descida paulatina dos autoanticorpos.Palavras-chave. Nefrite; Glomerulonefrite; Shunt; Autoimunidade; AntidsDNA; ANCA AbstractThe relationship between autoimmune disease and infection is well known in literature. However, the pathophysiologic role of infections in the development of autoimmunity is largely unknown. Furthermore, there are infections that occur with transient autoantibody positivity without any evidence of immunologic disease.Shunt nephritis (SN) is an immune complex mediated glomerulonephritis usually related with infection of ventriculoatrial shunt. Rarely, SN may be accompanied by positive immunological markers, like antinuclear and anti-neutrophil cytoplasm (ANCA) antibodies. In contrast, antibodies to double-stranded DNA (anti-dsDNA) are recognized by their specificity for the diagnosis of lupus, and have never been described in association with SN.The authors present the case of a NS with positivity for both PR3-ANCA and for anti-dsDNA in which there was no manifestation of autoimmune disease and the resolution of the infection led to the gradual decline of autoantibodies.Key words: Nephrite; Glomerulonephritis; Shunt; Autoimmunity; AntidsDNA; ANCA IntroduçãoAs doenças autoimunes surgem, habitualmente, como resultado da combinação de diversos factores, nomeadamente gené-ticos, imunológicos, hormonais e ambientais, compreendendo a conhecida designação de "mosaico da autoimunidade". Dentro dos factores ambientais, as infeções desempenham um papel preponderante, estando amplamente descrita na literatura a relação entre infeção e autoimunidade 1 . Por outro lado, a positividade transitória de autoanticorpos durante infecções agudas, sem evidência de doença imunológica, é também conhecida 2 .A nefrite de shunt (NS), descrita pela primeira vez por Black et al em 1965, é uma glomerulonefrite mediada por imunocomplexos 3 . Ocorre geralmente em doentes com infeção de shunts ventrículo-auriculares implantados por hidrocefalia adquirida ou congénita 4 . A sua incidência é baixa, estim...

show abstract

Shunt nephritis from Propionibacterium acnes in a solitary kidney

Cited by 12 publications

References 32 publications

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

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

Shunt Nephritis: A Rare and Forgotten Diagnosis

Um caso de Nefrite de shunt associada a elevação transitória de anticorpos anti-dsDNA

Contact Info

Product

Resources

About