Shunt nephritis in one 11-year old boy

Shunt nephritis (SN) is a rare immune-complex mediated glomerulonephritis, representing a reaction to low-virulent bacteria originating from chronically infected shunts inserted for the treatment of hydrocephalus, or more rarely from other implanted devices placed into the blood vessels. B l a c k e t a l. in 1965. first described it. The incidence of SN is undefined. Patients with SN are at risk of renal impairment, sepsis and harmful surgical therapy. The treatment of SN consists of antimicrobial therapy and removal of the shunt. 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. He developed SN from the ventriculo-atrial shunt infected with Staphylococcus epidermidis. After antimicrobial therapy had failed, he was treated successfully by both antimicrobial and surgical therapy. The early diagnosis of SN is of major importance for its prognosis because the insidious course can sometimes lead in to the wrong direction, giving a chance for the SN to progress. Our patient experienced neurological complications during the surgical removing of shunt. Despite of that, the chances for the patient's life are better if complete therapy is properly carried out. Our case corresponds to other reports from literature, proposing the implantation of ventriculo-peritoneal shunts whenever possible. Because of the relatively good prognosis, we suggest that kidney biopsy should be preserved only for cases of persistent nephritis and progressive deterioration of kidney function.