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Shunt Nephritis


Presentation

  • 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 ventriculojugular shunt placement.[ncbi.nlm.nih.gov]
  • Transient arthritis with positive tests for rheumatoid factor as presenting sign of shunt nephritis. Ann Rheum Dis 1991 ; 50 : 182 –3. 2 Aelion JA, Pinals RS. Arthritis associated with ventriculo‐atrial shunt.[doi.org]
Lymphadenopathy
  • Immune complex glomerulonephritis seen in 4% of infants with infected ventriculoatrial, ventriculojugular or ventriculoperitoneal shunts Clinical Weight loss, lethargy, fever, lymphadenopathy, hepatosplenomegaly, HTN, arthralgia, nephrotic syndrome, often[medical-dictionary.thefreedictionary.com]
Fishing
  • Am J Med. 1975 Sep; 59 (3):417–423. [ PubMed ] [ Google Scholar ] Dobrin RS, Day NK, Quie PG, Moore HL, Vernier HL, Michael AF, Fish AJ.[ncbi.nlm.nih.gov]
  • ., Fish, A. J. The role of complement, immunoglobulin and bacterial antigen in coagulase-negative staphylococcal shunt nephritis. Am. J. Med. 59 (1975) 660–673. Google Scholar 15. Bolton, W. K., Sande, M. A., Normansell, D. E., Sturgill, B.[link.springer.com]
Leg Edema
  • A 60-year-old woman who had a VA shunt implanted for hydrocephalus began to show intermittent low-grade fever of an unknown origin, as well as hypertension and lower leg edema.[keio.pure.elsevier.com]
Anorexia
  • The delay of diagnosis in this case was in part due to nonspecific symptoms such as fever, lethargy and anorexia.[docksci.com]
Fever of Unknown Origin
  • He began to show intermittent fever of unknown origin from the 3rd postoperative day. Blood culture yielded a few colonies of Staphylococcus epidermidis.[kundoc.com]
Overeating
  • The incidence of shunt nephritis has decreased over the past several years due to the increased use of ventriculoperitoneal (VP) shunts rather than the ventriculovascular systems for which this complication was originally reported in 1965.[ncbi.nlm.nih.gov]
  • Over half of individuals with shunt nephritis recover completely; most of the remainder have some degree of persistent kidney disease.[en.wikipedia.org]
  • Fogo has published over 280 research articles and reviews and has authored two textbooks of renal pathology.[books.google.de]
Vascular Disease
  • The chapters address the different types of glomerular, tubulointerstitial and vascular diseases, associated with bacterial infections, describe diagnostic pitfalls, provide differential diagnosis and discuss treatment and management.[books.google.com]
Hepatosplenomegaly
  • All patients had signs of infection, i.e. recurrent fever, hepatosplenomegaly, anaemia, and cerebral symptoms.[doi.org]
  • Immune complex glomerulonephritis seen in 4% of infants with infected ventriculoatrial, ventriculojugular or ventriculoperitoneal shunts Clinical Weight loss, lethargy, fever, lymphadenopathy, hepatosplenomegaly, HTN, arthralgia, nephrotic syndrome, often[medical-dictionary.thefreedictionary.com]
Myalgia
  • Her medical condition was stable until the age of 26, when she started to experience recurrent fever episodes and myalgia occurring exclusively, but not always, when taking showers.[docksci.com]
Asthenia
  • Arthritis of the wrists and arthralgia of the elbows occurred 3 yr later, along with febrile purpura of her legs and asthenia.[doi.org]
Tremor
  • A flapping tremor was absent, the Glasgow coma scale was 15/15. Laboratory test on admission are listed in Table 1. Severe renal failure and a nephrotic syndrome were diagnosed.[academic.oup.com]

Workup

  • The diagnostic workup and management of this disease is discussed.[ncbi.nlm.nih.gov]
  • Workup often shows hypocomplementemia ( C3/C4), renal failure, eosinophilia and eosinophiluria.[medicalmediareview.com]
  • MD, University of Texas Health Sciences Center San Antonio Quick-brain MRI (also known as rapid-brain MRI, rapid-sequence MRI, fast-sequence MRI, single-shot fast-spin echo) is quickly replacing CT as the diagnostic imaging modality of choice in the workup[ahcmedia.com]
  • Diagnosis of Nephrotic Syndrome Because of these considerations, our recommendations for the initial workup of adults with nephrotic syndrome are outlined in Table 6.[jamanetwork.com]
Enlargement of the Spleen
  • Recurrent fever, enlarged liver and spleen, and a skin rash may also be present. Rarely, the major complaint may be arthritis. Shunt nephritis occurs when a shunt becomes infected with bacteria, most commonly Staphylococcus epidermidis.[en.wikipedia.org]
Gram-Positive Coccus
  • A gram-positive coccus, Gemella morbillorum, was recovered from her blood as well as cerebrospinal fluid, and the culture of the shunt catheter established the diagnosis of shunt nephritis.[ncbi.nlm.nih.gov]
Liver Biopsy
  • A liver biopsy was repeated and showed a histological evolution of the incomplete septal cirrhosis to a picture of vanishing bile duct disease (grade IV). Immunohistochemical staining for hepatitis B and C were negative.[academic.oup.com]

Treatment

  • Abstract BACKGROUND: Shunt nephritis is an immune-complex-mediated glomerulonephritis (GN) associated with chronically infected ventriculoatrial shunts inserted for treatment of hydrocephalus.[doi.org]
  • The patient recovered completely after removal of the shunt and antibiotic treatment.[ncbi.nlm.nih.gov]

Prognosis

  • It generally has a good prognosis in the majority of early diagnosed and properly cured cases. Some cases of SN have a poor prognosis despite of a good therapeutical approach. Our patient was an 11-year old boy with two implanted shunts.[paedcro.com]
  • Treatment involves mandatory removal of the shunt and antibiotics; prognosis is variable.[ncbi.nlm.nih.gov]
  • S albus Treatment Antibiotics, high-dose prednisone Prognosis 1 2 resolve with therapy, 1 4 have persistent urine abnormalities; 1 4 die of the neurologic defects necessitating ventricular shunt[medical-dictionary.thefreedictionary.com]

Etiology

  • These findings support the potential role of C. bovis as an etiologic agent in human renal disease and further define the immune complex nature of shunt nephritis.[ncbi.nlm.nih.gov]
  • 181 Temperature Regulation 182 Additional Nursing Care 183 Syndrome of Inappropriate Secretion of Antidiuretic Hormone 184 Preoperative Baseline 185 Postoperative Complications 186 Outcomes 187 References 188 Spine 191 Traumatic Spinal Cord Injuries Etiology[books.google.de]
  • Keywords: GLOMERULONEPHRITIS-etiology; CEREBROSPINAL FLUID SHUNTS-adverse effect Category: Case report Volume: Vol. 44, No 4, october - december 2000 Authors: M. Saraga, Đ. Vukić-Košuljandić Reference work: DOI:[paedcro.com]
  • Infection of cerebrospinal fluid shunts in infants: a study of etiological factors. J Neurosurg 1992; 77: 29-36. 11. Shapino S, Boaz J, Kleinmem M, et al. Origins of organisms infected ventricular shunts. Neurosurgery 1988; 22: 868-872. 12.[degruyter.com]

Epidemiology

  • Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy. J Infect Dis. 1975 May; 131 (5):543–552. [ PubMed ] [ Google Scholar ] Sells CJ, Shurtleff DB, Loeser JD.[ncbi.nlm.nih.gov]
  • Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations and therapy. J. Infect. Dis. 131 (1975) 543–553. Google Scholar 19. McLaurin, R. L. Infected cerebrospinal shunts. Surg. Neurol. 1 (1973) 191–195. Google Scholar 20.[link.springer.com]
  • Infections of cerebrospinal fluid shunts: epidemiology, clinical manifestations, and therapy. J. Infect. Dis. 131 : 543 – 552. 65. Sells, C. J., , D. B. Shurtleff, , and J. D. Loeser. 1977.[asmscience.org]
  • Currently, S aureus is the most common pathogen recognized. [10] Shunt nephritis may be associated with ventriculovascular, ventriculoperitoneal, peritoneovascular, or vascular shunts. [11] Epidemiology The various causes of infection-related GN have[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This study of pathologic and laboratory changes following therapy suggests that the pathophysiology of the nephritis was based on an immunologic process, and that removal of antigen resulted in reversal of glomerular changes.[ncbi.nlm.nih.gov]
  • Nursing Care 200 Summary 202 KlippelFeil Syndrome 205 Outcomes 206 Summary 208 Neurovascular Disease 211 Arterial Supply 212 Venous Supply 213 Vein of Galen Aneurysmal Malformations 214 Diagnostic Tests 215 Treatment Options 216 Family Education 217 Pathophysiology[books.google.de]

Prevention

  • Prevention of bacterial endocarditis. ‏[books.google.com]
  • Prevention of bacterial endocarditis. ‎[books.google.de]
  • The etiology and prevention of shunt nephritis. Z. Kinderchir. 28 (1979) 377–384. Google Scholar 22. Narchi, H., Taylor, R., Azmy, A. F., Murphy, A. V., Beattie, T. J. Shunt nephritis. J. Paediatr. Surg. 23 (1988) 839–841. Google Scholar 23.[link.springer.com]
  • Endovascular retrieval of migrated shunts is less invasive, is feasible, and prevents further complications.[pediatricneurosciences.com]
  • The shunts divert CSF away from the ventricles, preventing increases in intracranial pressure that lead to neurologic sequelae.[mhmedical.com]

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