These shunts are associated with a myriad of complications [5,6] and unique among these is an immunologic phenomenon termed shunt nephritis. This refers to a glomerulonephritis characterized by proteinuria and hematuria which is associated with chronically infected shunts and usually resolves after treatment of the infection, removal of the shunt, or both.
We identified 79 individual cases of shunt nephritis from 58 articles in this literature, which we further reviewed [7, 9-65].
The pathogenetic mechanism of shunt nephritis is not clear.
Four patients had negative blood, CSF, and shunt cultures, socalled culture-negative shunt nephritis [9, 43, 60, 61].
From the 79 patients with shunt nephritis that we reviewed, there is a slight male predominance, that is, 43 males versus 36 females.
Shunt nephritis may present with variable nonspecific signs and symptoms, most commonly hematuria, fever, hypertension, and hepatosplenomegaly (see Table 3).
Some patients do present with positive anti-neutrophil cytoplasmic antibody (ANCA) titers, all antiproteinase 3 positive, with decrease in titers after treatment of the shunt nephritis [15,31, 36,42].
Of the 79 shunt nephritis patients reviewed, 62 had renal biopsies with 8 of these patients having repeat biopsies after treatment of the nephritis.
The initial success of ventriculo-atrial shunting was complicated by blood-borne infections which spread to the kidneys and presented significant problems to renal function (shunt nephritis
) as well as the need for frequent surgical procedures to lengthen the tubing.[1,9] These problems led to the current surgical preference for the peritoneum as a site for the distal tubing.[12,14]