Background: Shunt nephritis is autoimmune complex-mediated glomerulonephritis rarely encountered complication following ventriculoatrial shunt (VAS). It's reported to occur after an average of 5.8 years of shunt insertion. We systemically analyzed the literature to know the time of VAS removal that is associated with good renal function recovery.
Methods: We report an unusual case of a 51-year-old female who presented with shunt nephritis 35 years after VAS implantation. This is the longest duration to be reported up to our literature review. A systematic literature review was conducted to assess the factors associated with renal function outcomes in patients with VAS who developed shunt nephritis.
Results: Our patient showed a full renal recovery after seven weeks of diagnosis; the atrial catheter was removed, and her shunt was converted to a ventriculopleural shunt (VPLS). Twenty-one articles met the inclusion criteria of our review. Age at shunt insertion of < 3 months is associated with a 66.7% incidence of poor renal outcome (P-value = 0.004). The time from shunt nephritis onset to shunt removal was positively associated with a higher risk of end-stage renal disease or death. A 3-month delay or longer is associated with an odds ratio of 22.4 of poor outcomes (95% confidence interval (CI)=2.2 - 228.7). The time from insertion to nephritis was not significantly associated with the outcome.
Conclusion: The sooner the shunt is removed within a 3-month interval from the diagnosis of shunt nephritis, the better the outcome, regardless of the time interval from shunt insertion until the development of shunt nephritis.
Keywords: Complications; Proteinuria; Shunt nephritis; Ventriculoatrial shunt.
Copyright © 2022 Elsevier B.V. All rights reserved.