Nephrology Dialysis Transplantation, Vol 12, Issue 6 1143-1148, Copyright © 1997 by Oxford University Press
D Haffner, F Schindera, A Aschoff, S Matthias, R Waldherr and K Scharer
Background. Shunt nephritis is an
immune-complex-mediated glomerulonephritis (GN) associated with chronically
infected ventriculoatrial shunts inserted for treatment of hydrocephalus.
Methods. Six patients aged 5-22 years with shunt
nephritis are reported who have been observed between 1971 and 1994. The
clinical course and long-term outcome are analysed in relation to the time
of diagnosis and renal histopathology. Results. The
time of diagnosis of shunt nephritis ranged from 0.3 to 4.5 years after the
last shunt operation. Diagnosis was delayed up to 1.5 years after the first
clinical manifestations. All patients had signs of infection, i.e.
recurrent fever, hepatosplenomegaly, anaemia, and cerebral symptoms. Renal
manifestations consisted of haematuria (macroscopic in 3 patients),
proteinuria (heavy in 5), renal insufficiency (4) and hypertension (2).
Decreased C3 levels, cryoglobulins, and antinuclear factors were frequent.
Cultures of blood and cerebrospinal fluid provided growth mainly of
S. epidermidis. Renal biopsy revealed endocapillary GN
(1), membranoproliferative GN (1) and endocapillary/extracapillary GN with
crescents (2). All patients received antibiotics i.v. Complete recovery was
observed in three of four patients in whom the shunt was totally removed,
supported by transient external drainage of cerebrospinal fluid, and
followed by placement of a ventriculoperitoneal shunt. One child with
delayed diagnosis, presenting with a serum creatinine of 3.2 mg/dl,
hypertension, and severe scarring on renal biopsy, rapidly progressed to
irreversible ESRD within 5 months. Two patients without and only partial
removal of the shunt died subsequently from sepsis.
Conclusions. The renal outcome of shunt nephritis is
good if early diagnosis and treatment is provided including i.v.
antibiotics and total removal of the infected shunt. The possible
progression to ESRD requires frequent nephrological monitoring of patients
with ventriculoatrial shunts. Keywords: end-stage
renal disease; dialysis; infection; shunt nephritis; ventriculoatrial
shunts.
ORIGINAL ARTICLES
The clinical spectrum of shunt nephritis
Departments of Paediatrics, Neurosurgery, Internal Medicine and Pathology, University of Heidelberg; and Children's Hospital, Karlsruhe, Germany; Corresponding author address: Division of Paediatric Nephrology, University of Children's Hospital, Im Neuenheimer Feld 150D - 69120 Heidelberg, Germany
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