Shunt Nephritis: Histological Dynamics Following Removal of the Shunt. Case Report and Review of the Literature

Diffuse crescentic glomerulonephritis was observed in a 40-year-old male patient who had a ventriculoatrial shunt implanted after a traffic accident 10 years previously. Immediately after treatment with immunosuppressants and plasma pheresis, signs of meningitis and septicemia developed. The responsible organism isolated was Staphylococcus albus. After the shunt was removed, clinical signs and renal function improved, associated with normalization of hypocomplementemia and disappearance of cryoglobulin and circulating immune complexes. Repeat renal biopsy performed 5 months after the removal of the shunt revealed mild mesangial proliferative and sclerotic glomerulonephritis with fibrous crescents. No apparent deposits observed in the initial biopsy were found on ultrastructural and immunofluorescent examinations. The reported cases with serial renal biopsies before and after the removal of the shunt were reviewed.