title: The clinical spectrum of shunt nephritis.
abstract: 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.
authors.affiliation: Department of Paediatrics, University of Heidelberg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Haffner
authors.forename: F
authors.initials: F
authors.lastname: Schindera
authors.forename: A
authors.initials: A
authors.lastname: Aschoff
authors.forename: S
authors.initials: S
authors.lastname: Matthias
authors.forename: R
authors.initials: R
authors.lastname: Waldherr
authors.forename: K
authors.initials: K
authors.lastname: Schärer
mesh_terms: D000328:Adult; D000974:Antibodies, Antinuclear / Q000032:analysis; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D003176:Complement C3 / Q000032:analysis; D003450:Cryoglobulins / Q000032:analysis; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000473:pathology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000628:therapy; D006973:Hypertension / Q000209:etiology; D011507:Proteinuria / Q000209:etiology; D051437:Renal Insufficiency / Q000209:etiology; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000150:complications*
chemical_list: D000974:Antibodies, Antinuclear; D003176:Complement C3; D003450:Cryoglobulins