Hart Ilgizar, Okamoto Keisuke, Teruel Benjamin R, McMahon Blaithin A
Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina.
Deparment of Nephrology, Nara Medical University, Kashihara, Japan.
J Neurosurg Case Lessons. 2025 Mar 10;9(10). doi: 10.3171/CASE24546.
Shunt nephritis, although rare, should be high in the differential diagnoses for patients with gross or microscopic hematuria and a history of a ventriculoatrial/cystoatrial shunt.
The authors present the case of a 31-year-old female with a history of a resected posterior fossa hemangioblastoma and hydrocephalus, who presented to the nephrology clinic with night sweats and tea-colored urine for 3 months after being hospitalized for a saddle pulmonary embolism; kidney biopsy was contraindicated. The patient had hypocomplementemia, nephrotic-range proteinuria, positive proteinase 3-specific antineutrophil cytoplasmic antibody, and dysmorphic red blood cells in the urine sediment. CSF culture grew Propionibacterium acnes. The patient was diagnosed with shunt nephritis without the need for a kidney biopsy. The patient was treated with ceftriaxone and surgical shunt removal. Hematuria, proteinuria, and night sweats resolved 3 weeks later. A ventriculoperitoneal shunt was placed 4 months later for persistent hydrocephalus.
Shunt nephritis is a rare type of glomerulonephritis that can progress to end-stage renal disease or death if the diagnosis is delayed or not established. Definitive treatment involves antibiotic therapy and surgical shunt removal. This case highlights that a kidney biopsy is not necessary for diagnosis in all cases, and aspiration of shunt fluid could be all that is required to determine a diagnosis. https://thejns.org/doi/10.3171/CASE24546.
分流性肾炎虽然罕见，但在有肉眼或镜下血尿且有脑室-心房/囊肿-心房分流病史的患者的鉴别诊断中应予以高度考虑。
作者报告了一例31岁女性病例，该患者有后颅窝血管母细胞瘤切除及脑积水病史，因鞍区肺栓塞住院后3个月出现盗汗和茶色尿，就诊于肾病科；肾活检属禁忌。患者有补体血症、肾病范围蛋白尿、蛋白酶3特异性抗中性粒细胞胞浆抗体阳性及尿沉渣中异形红细胞。脑脊液培养出痤疮丙酸杆菌。患者未经肾活检即被诊断为分流性肾炎。患者接受头孢曲松治疗及手术移除分流管。3周后血尿、蛋白尿和盗汗症状消失。4个月后因持续性脑积水置入脑室-腹腔分流管。
分流性肾炎是一种罕见的肾小球肾炎类型，如果诊断延迟或未确立，可进展为终末期肾病或死亡。明确的治疗包括抗生素治疗及手术移除分流管。该病例强调，并非所有病例诊断都需要肾活检，确定诊断可能仅需抽取分流液。https://thejns.org/doi/10.3171/CASE24546
