Shunt nephritis with positive titers for ANCA specific for proteinase 3.
The authors report a case of shunt nephritis with antineutrophil cytoplasmic autoantibody (ANCA) and review 2 similar cases. A 55-year-old man was admitted to our hospital for continuous fever and foot edema in 2002. A ventriculoperitoneal shunt was implanted because of a brain abscess and subsequent hydrocephalus in 1987; it was changed to a ventriculoatrial (VA) shunt in 1995. Urinary analysis showed proteinuria (5.4 g/d) and microscopic hematuria. Laboratory data showed renal dysfunction and hypocomplementemia. ANCA specific for proteinase 3 (PR3-ANCA) was positive in his serum, and blood culture grew Propionibacterium acnes. Renal biopsy results showed membranoproliferative glomerulonephritis type I. Therefore, the VA shunt was replaced, and antibiotics were administered. Oral prednisolone was initiated at a dose of 50 mg/d. Proteinuria and the serum levels of creatinine were improved concomitant with normalization of the serum complement levels and the decrease in serum PR3-ANCA titer. Similarly, another 2 cases reported in the literature of PR3-ANCA-positive shunt nephritis caused by P acnes and Gemella morbillorum showed good outcomes after removal of the shunt and administration of antibiotics with or without steroid therapy.
Iwata
Yasunori
Y
Department of Internal Medicine, Toyama City Hospital, Toyama, Japan. yiwata@tch.toyama.toyama.jp
Ohta
Satoshi
S
Kawai
Kengo
K
Yamahana
Junya
J
Sugimori
Hiroko
H
Ishida
Yoh-ichi
Y
Saito
Katsuhiko
K
Miyamori
Tadao
T
Futami
Kazuya
K
Arakawa
Yasuaki
Y
Hirota
Yuh-ichi
Y
Wada
Takashi
T
Yokoyama
Hitoshi
H
Yoshida
Kohjiro
K
D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015432:Glomerulonephritis, Membranoproliferative / Q000097:blood* / Q000209:etiology*; D016908:Gram-Positive Bacterial Infections / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D053146:Myeloblastin; D011425:Propionibacterium acnes / Q000302:isolation & purification*; D012697:Serine Endopeptidases / Q000276:immunology*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
D019268:Antibodies, Antineutrophil Cytoplasmic; D012697:Serine Endopeptidases; D053146:Myeloblastin