Shunt Nephritis: An Increasingly Unfamiliar Diagnosis.

Shunt Nephritis: An Increasingly Unfamiliar Diagnosis.

World Neurosurg. 2018 Jan 08;:

Authors: Harland TA, Winston KR, Jovanovich AJ, Johnson RJ

Abstract
BACKGROUND: Shunt nephritis is a rare, reversible immune-complex mediated complication of CSF shunt infection that can progress to end-stage renal disease and even death if diagnosis is delayed.
CASE DESCRIPTION: The present case report details the manifestation and clinical course of shunt nephritis in a 50-year old patient who presented with symptoms of nephrotic syndrome 30 years after ventriculo-jugular shunt placement. Diagnosis was delayed due to initial negative CSF and blood cultures but later a CSF culture was positive for Propionibacterium acnes. After treatment with IV antibiotics and complete removal of shunt with subsequent replacement with a new ventriculo-peritoneal shunt, the nephritic symptoms resolved but the patient continued to have reduced kidney function consistent with chronic kidney disease stage IIIa.
CONCLUSION: This case emphasizes the clinical importance of having a high index of suspicion in patients with ventricular shunt who present with symptoms consistent with nephritis, even in the setting of negative cultures and delayed presentation.

PMID: 29325951 [PubMed - as supplied by publisher]

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