Shunt nephritis

Role of the complement system in its pathogenesis and management

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  • 1 Division of Neurosurgery, Department of Surgery and Division of Nephrology, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
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✓ Three cases of shunt nephritis in which serial complement levels were obtained during the course of treatment are presented to illustrate the value of monitoring complement levels in the management of this condition. In shunt nephritis, circulating immune complexes are formed which contain antigen from bacteria of low virulence. These complexes, which activate the classical complement pathway, are reflected in most cases by lowering of the serum levels of C1, C2, C4, and C3. These levels promptly return to normal after the initiation of effective therapy. Serial determinations of serum levels of complement protein provide a sensitive and reliable method for early determination of efficacy of therapy in shunt nephritis.

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Contributor Notes

Address reprint requests to: Robert J. Wyatt, M.D., Department of Pediatrics, University of Kentucky Medical Center, College of Medicine, University of Kentucky, Lexington, Kentucky 40536.
  • 1.

    Agnello V, , Winchester RJ, & Kunkel HG: Precipitin reactions of the C1q component of complement with aggregated γ-globulin and immune complexes in gel diffusion. Immunology 19:909919, 1970 Agnello V, Winchester RJ, Kunkel HG: Precipitin reactions of the C1q component of complement with aggregated γ-globulin and immune complexes in gel diffusion. Immunology 19:909–919, 1970

    • Search Google Scholar
    • Export Citation
  • 2.

    Augener W, , Grey HM, & Cooper NR, et al: The reaction of monomeric and aggregated immunoglobulins with C1. Immunochemistry 8:10111020, 19711 Augener W, Grey HM, Cooper NR, et al: The reaction of monomeric and aggregated immunoglobulins with C1. Immunochemistry 8:1011–1020, 1971

    • Search Google Scholar
    • Export Citation
  • 3.

    Bayston R, & Swinden J: The aetiology and prevention of shunt nephritis. Z Kinderchir Grenzgeb 28:377384, 1979 Bayston R, Swinden J: The aetiology and prevention of shunt nephritis. Z Kinderchir Grenzgeb 28:377–384, 1979

    • Search Google Scholar
    • Export Citation
  • 4.

    Beeler BA, , Crowder JG, & Smith JW, et al: Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis. Am J Med 61:935938, 1976 Beeler BA, Crowder JG, Smith JW, et al: Propionibacterium acnes: pathogen in central nervous system shunt infection. Report of three cases including immune complex glomerulonephritis. Am J Med 61:935–938, 1976

    • Search Google Scholar
    • Export Citation
  • 5.

    Black JA, , Challacombe DN, & Ockenden BG: Nephrotic syndrome associated with bacteraemia after shunt operations for hydrocephalus. Lancet 2:921924, 1965 Black JA, Challacombe DN, Ockenden BG: Nephrotic syndrome associated with bacteraemia after shunt operations for hydrocephalus. Lancet 2:921–924, 1965

    • Search Google Scholar
    • Export Citation
  • 6.

    Bolton WK, , Sande MA, & Normansell DE, et al: Ventriculojugular shunt nephritis with Corynebacterium bovis. Am J Med 59:417423, 1975 Bolton WK, Sande MA, Normansell DE, et al: Ventriculojugular shunt nephritis with Corynebacterium bovis. Am J Med 59:417–423, 1975

    • Search Google Scholar
    • Export Citation
  • 7.

    Caron C, , Luneau C, & Gervais MH, et al: La glomérulonéphrite de shunt: manifestations clinques et histopathologiques. Can Med Assoc J 120:557561, 1979 Caron C, Luneau C, Gervais MH, et al: La glomérulonéphrite de shunt: manifestations clinques et histopathologiques. Can Med Assoc J 120:557–561, 1979

    • Search Google Scholar
    • Export Citation
  • 8.

    Cochrane CG, & Müller-Eberhard HJ: The derivation of two distinct anaphylatoxin activities from the third and fifth components of human complement. J Exp Med 127:371386, 1968 Cochrane CG, Müller-Eberhard HJ: The derivation of two distinct anaphylatoxin activities from the third and fifth components of human complement. J Exp Med 127:371–386, 1968

    • Search Google Scholar
    • Export Citation
  • 9.

    Dobrin RS, , Day NK, & Quie PG, et al: The role of complement, immunoglobulin and bacterial antigen in coagulase-negative staphylococcal shunt nephritis. Am J Med 59:660673, 1975 Dobrin RS, Day NK, Quie PG, et al: The role of complement, immunoglobulin and bacterial antigen in coagulase-negative staphylococcal shunt nephritis. Am J Med 59:660–673, 1975

    • Search Google Scholar
    • Export Citation
  • 10.

    Finney HL, & Roberts TS: Nephritis secondary to chronic cerebrospinal fluid—vascular shunt infection: “shunt nephritis.” Childs Brain 6:189183, 1980 Finney HL, Roberts TS: Nephritis secondary to chronic cerebrospinal fluid—vascular shunt infection: “shunt nephritis.” Childs Brain 6:189–183, 1980

    • Search Google Scholar
    • Export Citation
  • 11.

    Fugita T, , Gigli I, & Nussenzweig V: Human C4-binding protein. II. Role in proteolysis of C4b by C3b-inactivator. J Exp Med 148:10441051, 1978 Fugita T, Gigli I, Nussenzweig V: Human C4-binding protein. II. Role in proteolysis of C4b by C3b-inactivator. J Exp Med 148:1044–1051, 1978

    • Search Google Scholar
    • Export Citation
  • 12.

    Greene CA, , Rao VS, & Maragos GD, et al: Complications of infected ventriculoatrial shunt for hydrocephalus—a case report. Nebr Med J 57:3943, 1972 Greene CA, Rao VS, Maragos GD, et al: Complications of infected ventriculoatrial shunt for hydrocephalus—a case report. Nebr Med J 57:39–43, 1972

    • Search Google Scholar
    • Export Citation
  • 13.

    Habib R, , Kleinknecht C, & Gubler MC, et al: Idiopathic membranoproliferative glomerulonephritis in children. Report of 105 cases. Clin Nephrol 1:194214, 1973 Habib R, Kleinknecht C, Gubler MC, et al: Idiopathic membranoproliferative glomerulonephritis in children. Report of 105 cases. Clin Nephrol 1:194–214, 1973

    • Search Google Scholar
    • Export Citation
  • 14.

    Halmagyi GM, & Horvath JS: Acute glomerulonephritis in an adult with infected ventriculoatrial shunt. Med J Aust 1:136137, 1979 Halmagyi GM, Horvath JS: Acute glomerulonephritis in an adult with infected ventriculoatrial shunt. Med J Aust 1:136–137, 1979

    • Search Google Scholar
    • Export Citation
  • 15.

    Harkiss GD, , Brown DL, & Evans DB: Longitudinal study of circulating immune complexes in a patient with Staphylococcus albus-induced shunt nephritis. Clin Exp Immunol 37:228238, 1979 Harkiss GD, Brown DL, Evans DB: Longitudinal study of circulating immune complexes in a patient with Staphylococcus albus-induced shunt nephritis. Clin Exp Immunol 37:228–238, 1979

    • Search Google Scholar
    • Export Citation
  • 16.

    Hill JH, & Ward PA: C3 leukotactic factors produced by a tissue protease. J Exp Med 130:505518, 1969 Hill JH, Ward PA: C3 leukotactic factors produced by a tissue protease. J Exp Med 130:505–518, 1969

    • Search Google Scholar
    • Export Citation
  • 17.

    Holland N: Hypocomplementemic glomerulonephritis associated with micrococcus infection of ventriculoatrial shunt. 37th Annual Meeting of the Society for Pediatric Research, 1967 (Abstract) Holland N: Hypocomplementemic glomerulonephritis associated with micrococcus infection of ventriculoatrial shunt. 37th Annual Meeting of the Society for Pediatric Research, 1967 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 18.

    Holland NH, , De Bracco MME, & Christian CL: Pathways of complement activation in glomerulonephritis. Kidney Int 1:106114, 1972 Holland NH, De Bracco MME, Christian CL: Pathways of complement activation in glomerulonephritis. Kidney Int 1:106–114, 1972

    • Search Google Scholar
    • Export Citation
  • 19.

    Kaufman DB, & McIntosh R: The pathogenesis of the renal lesion in a patient with streptococcal disease, infected ventriculoatrial shunt, cryoglobulinemia and nephritis. Am J Med 50:262268, 1971 Kaufman DB, McIntosh R: The pathogenesis of the renal lesion in a patient with streptococcal disease, infected ventriculoatrial shunt, cryoglobulinemia and nephritis. Am J Med 50:262–268, 1971

    • Search Google Scholar
    • Export Citation
  • 20.

    Kent JF, & Fife EH Jr: Precise standardization of reagents for complement fixation. Am J Trop Med Hyg 12:103116, 1963 Kent JF, Fife EH Jr: Precise standardization of reagents for complement fixation. Am J Trop Med Hyg 12:103–116, 1963

    • Search Google Scholar
    • Export Citation
  • 21.

    Kohler PF, & Ten Bensel R: Serial complement component alterations in acute glomerulonephritis and systemic lupus erythematosus. Clin Exp Immunol 4:191202, 1969 Kohler PF, Ten Bensel R: Serial complement component alterations in acute glomerulonephritis and systemic lupus erythematosus. Clin Exp Immunol 4:191–202, 1969

    • Search Google Scholar
    • Export Citation
  • 22.

    Kolb WP, , Haxby JA, & Arroyave CM, et al: Molecular analysis of the membrane attack mechanism of complement. J Exp Med 135:549566, 1972 Kolb WP, Haxby JA, Arroyave CM, et al: Molecular analysis of the membrane attack mechanism of complement. J Exp Med 135:549–566, 1972

    • Search Google Scholar
    • Export Citation
  • 23.

    Labrune B, , Levy M, & Bauby C, et al: Les glomerulonephrites secondaires aux derivations ventriculo-atriales (“shunt nephritis”). A propos de 2 observations personnelles. Arch Fr Pediatr 30:793808, 1973 Labrune B, Levy M, Bauby C, et al: Les glomerulonephrites secondaires aux derivations ventriculo-atriales (“shunt nephritis”). A propos de 2 observations personnelles. Arch Fr Pediatr 30:793–808, 1973

    • Search Google Scholar
    • Export Citation
  • 24.

    Lam CN, , McNeish AS, & Gibson AAM: Nephrotic syndrome associated with complement deficiency and Staphylococcus albus bacteraemia. Scott Med J 14:8688, 1969 Lam CN, McNeish AS, Gibson AAM: Nephrotic syndrome associated with complement deficiency and Staphylococcus albus bacteraemia. Scott Med J 14:86–88, 1969

    • Search Google Scholar
    • Export Citation
  • 25.

    Lewis EJ, , Carpenter CB, & Schur PH: Serum complement component levels in human glomerulonephritis. Ann Int Med 75:555560, 1971 Lewis EJ, Carpenter CB, Schur PH: Serum complement component levels in human glomerulonephritis. Ann Int Med 75:555–560, 1971

    • Search Google Scholar
    • Export Citation
  • 26.

    Marini G, , Gabriele PW, & Tanghetti B, et al: Membranoproliferative glomerulonephritis associated with infected ventriculoatrial shunt. Mod Probl Paediatr 18:207210, 1977 Marini G, Gabriele PW, Tanghetti B, et al: Membranoproliferative glomerulonephritis associated with infected ventriculoatrial shunt. Mod Probl Paediatr 18:207–210, 1977

    • Search Google Scholar
    • Export Citation
  • 27.

    Mayer MM: Mechanisms of cytolysis by complement. Proc Natl Acad Sci USA 69:29542958, 1972 Mayer MM: Mechanisms of cytolysis by complement. Proc Natl Acad Sci USA 69:2954–2958, 1972

    • Search Google Scholar
    • Export Citation
  • 28.

    McKenzie SA, & Hayden K: Two cases of “shunt nephritis.” Pediatrics 54:806808, 1974 McKenzie SA, Hayden K: Two cases of “shunt nephritis.” Pediatrics 54:806–808, 1974

    • Search Google Scholar
    • Export Citation
  • 29.

    Molz G, & Doswald T: Diffuse Glomerulonephritis bei Staphylokokken-infizierter ventriculoatrialer Liquordrainage. Schweiz Arch Neurol Neurochir Psychiatr 107:223230, 1970 Molz G, Doswald T: Diffuse Glomerulonephritis bei Staphylokokken-infizierter ventriculoatrialer Liquordrainage. Schweiz Arch Neurol Neurochir Psychiatr 107:223–230, 1970

    • Search Google Scholar
    • Export Citation
  • 30.

    Moncrieff MW, , Glasgow EF, & Arthur LJH, et al: Glomerulonephritis associated with Staphylococcus albus in a Spitz Holter valve. Arch Dis Child 48:6972, 1973 Moncrieff MW, Glasgow EF, Arthur LJH, et al; Glomerulonephritis associated with Staphylococcus albus in a Spitz Holter valve. Arch Dis Child 48:69–72, 1973

    • Search Google Scholar
    • Export Citation
  • 31.

    Monnier B, , Bauza R, & Barillon D, et al: Guérison apparente de “néphrite du shunt” après ablation du matériel de dérivation ventriculo-atriale. Une observation chez un adulte. Nouv Presse Med 7:3562, 1978 Monnier B, Bauza R, Barillon D, et al: Guérison apparente de “néphrite du shunt” après ablation du matériel de dérivation ventriculo-atriale. Une observation chez un adulte. Nouv Presse Med 7:3562, 1978

    • Search Google Scholar
    • Export Citation
  • 32.

    Moss SW, , Gary NE, & Eisinger RP: Nephritis associated with diphtheroid-infected cerebrospinal fluid shunt. Am J Med 63:318319, 1977 Moss SW, Gary NE, Eisinger RP: Nephritis associated with diphtheroid-infected cerebrospinal fluid shunt. Am J Med 63:318–319, 1977

    • Search Google Scholar
    • Export Citation
  • 33.

    Müller-Eberhard HJ: The molecular basis of the biological activities of complement. Harvey Lect 66:75104, 1970–1971 Müller-Eberhard HJ: The molecular basis of the biological activities of complement. Harvey Lect 66:75–104, 1970–1971

    • Search Google Scholar
    • Export Citation
  • 34.

    Müller-Eberhard HJ, , Polley MJ, & Calcott MA: Formation and functional significance of a molecular complex derived from the second and the fourth component of human complement. J Exp Med 125:359380, 1967 Müller-Eberhard HJ, Polley MJ, Calcott MA: Formation and functional significance of a molecular complex derived from the second and the fourth component of human complement. J Exp Med 125:359–380, 1967

    • Search Google Scholar
    • Export Citation
  • 35.

    Northway JD, , McAdams AJ, & West CD: Sepsis, nephritis and hypocomplementemia. 37th Annual Meeting of the Society for Pediatric Research, 1967 (Abstract) Northway JD, McAdams AJ, West CD: Sepsis, nephritis and hypocomplementemia. 37th Annual Meeting of the Society for Pediatric Research, 1967 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 36.

    Ooi YM, , Vallota EH, & West CD: Classical complement pathway activation in membranoproliferative glomerulonephritis. Kidney Int 9:4653, 1976 Ooi YM, Vallota EH, West CD: Classical complement pathway activation in membranoproliferative glomerulonephritis. Kidney Int 9:46–53, 1976

    • Search Google Scholar
    • Export Citation
  • 37.

    O'Regan S, & Makker SP: Case report. Shunt nephritis: demonstration of diphtheroid antigen in glomeruli. Am J Med Sci 278:161165, 1979 O'Regan S, Makker SP: Case report. Shunt nephritis: demonstration of diphtheroid antigen in glomeruli. Am J Med Sci 278:161–165, 1979

    • Search Google Scholar
    • Export Citation
  • 38.

    Peeters W, , Mussche M, & Becaus I, et al: Shunt nephritis. Clin Nephrol 9:122125, 1978 Peeters W, Mussche M, Becaus I, et al: Shunt nephritis. Clin Nephrol 9:122–125, 1978

    • Search Google Scholar
    • Export Citation
  • 39.

    Pierre-Kahn A, , Labrune B, & Levy M, et al: Glomérulonéphrites des dérivations ventriculo-atriales. Neurochirurgie 19:387398, 1973 Pierre-Kahn A, Labrune B, Levy M, et al: Glomérulonéphrites des dérivations ventriculo-atriales. Neurochirurgie 19:387–398, 1973

    • Search Google Scholar
    • Export Citation
  • 40.

    Rames L, , Wise B, & Goodman JR, et al: Renal disease with Staphylococcus albus bacteremia. A complication in ventriculoatrial shunts. JAMA 212:16711677, 1970 Rames L, Wise B, Goodman, JR, et al: Renal disease with Staphylococcus albus bacteremia. A complication in ventriculoatrial shunts. JAMA 212:1671–1677, 1970

    • Search Google Scholar
    • Export Citation
  • 41.

    Stauffer UG: “Shunt nephritis:” diffuse glomerulonephritis complicating ventriculo-atrial shunts. Dev Med Child Neurol (Suppl 22): 161164, 1970 Stauffer UG: “Shunt nephritis:” diffuse glomerulonephritis complicating ventriculo-atrial shunts. Dev Med Child Neurol (Suppl 22):161–164, 1970

    • Search Google Scholar
    • Export Citation
  • 42.

    Stickler GB, , Shin MH, & Burke EC, et al: Diffuse glomerulonephritis associated with infected ventriculoatrial shunt. N Engl J Med 279:10771082, 1968 Stickler GB, Shin MH, Burke EC, et al: Diffuse glomerulonephritis associated with infected ventriculoatrial shunt. N Engl J Med 279:1077–1082, 1968

    • Search Google Scholar
    • Export Citation
  • 43.

    Strife CF, , McDonald BM, & Ruley EJ, et al: Shunt nephritis: the nature of the serum cryoglobulins and their relation to the complement profile. J Pediatr 88:403413, 1976 Strife CF, McDonald BM, Ruley EJ, et al: Shunt nephritis: the nature of the serum cryoglobulins and their relation to the complement profile. J Pediatr 88:403–413, 1976

    • Search Google Scholar
    • Export Citation
  • 44.

    Vernier R, , Mauer SM, & Fish A, et al: The mesangial cell in glomerulonephritis, in Hamburger J, & Maxwell MH (eds): Advances in Nephrology. Chicago: Yearbook Medical, 1971, pp 3146 Vernier R, Mauer SM, Fish A, et al: The mesangial cell in glomerulonephritis, in Hamburger J, Maxwell MH (eds): Advances in Nephrology. Chicago: Yearbook Medical, 1971, pp 31–46

    • Search Google Scholar
    • Export Citation
  • 45.

    Vogt W, , Schmidt G, & von Buttlar B, et al: A new function of the activated third component of complement: binding to C5, an essential step for C5 activation. Immunology 34:2940, 1978 Vogt W, Schmidt G, von Buttlar B, et al: A new function of the activated third component of complement: binding to C5, an essential step for C5 activation. Immunology 34:29–40, 1978

    • Search Google Scholar
    • Export Citation
  • 46.

    Wald SL, & McLaurin RL: Shunt-associated glomerulonephritis. Neurosurgery 3:146150, 1978 Wald SL, McLaurin RL: Shunt-associated glomerulonephritis. Neurosurgery 3:146–150, 1978

    • Search Google Scholar
    • Export Citation
  • 47.

    Wegmann W, & Leumann EP: Glomerulonephritis associated with (infected) ventriculo-atrial shunt. Clinical and morphological findings. Virchows Arch 359:185200, 1973 Wegmann W, Leumann EP: Glomerulonephritis associated with (infected) ventriculo-atrial shunt. Clinical and morphological findings. Virchows Arch 359:185–200, 1973

    • Search Google Scholar
    • Export Citation
  • 48.

    West CD, , Hinrichs V, & Hinkle NH: Quantitative determination of the serum globulins, beta2A and beta2M by immunoelectrophoretic analysis. J Lab Clin Med 58:137148, 1961 West CD, Hinrichs V, Hinkle NH: Quantitative determination of the serum globulins, beta2A and beta2M by immunoelectrophoretic analysis. J Lab Clin Med 58:137–148, 1961

    • Search Google Scholar
    • Export Citation
  • 49.

    Wyatt RJ, , Forristal J, & Davis CA, et al: Control of serum C3 level by β1H and C3b inactivator. J Lab Clin Med 95:905917, 1980 Wyatt RJ, Forristal J, Davis CA, et al: Control of serum C3 level by β1H and C3b inactivator. J Lab Clin Med 95:905–917, 1980

    • Search Google Scholar
    • Export Citation
  • 50.

    Wyatt RJ, , McAdams AJ, & Forristal J, et al: Glomerular deposition of complement-control proteins in acute and chronic glomerulonephritis. Kidney Int 16:505512, 1979 Wyatt RJ, McAdams AJ, Forristal J, et al: Glomerular deposition of complement-control proteins in acute and chronic glomerulonephritis. Kidney Int 16:505–512, 1979

    • Search Google Scholar
    • Export Citation
  • 51.

    Yeh BP-Y, , Young HF, & Schatzki PF, et al: Immune complex disease associated with an infected ventriculojugular shunt: a curable form of glomerulonephritis. South Med J 70:1141 1146 1141–1143, 1146, 1977 Yeh BP-Y, Young HF, Schatzki PF, et al: Immune complex disease associated with an infected ventriculojugular shunt: a curable form of glomerulonephritis. South Med J 70:1141–1143, 1146, 1977

    • Search Google Scholar
    • Export Citation
  • 52.

    Zubler RH, , Lange G, & Lambert PH, et al: Detection of immune complexes in unheated sera by a modified 125I-C1q binding test. Effect of heating on the binding of C1q by immune complexes and application of the test to systemic lupus erythematosus. J Immunol 116:232235, 1976 Zubler RH, Lange G, Lambert PH, et al: Detection of immune complexes in unheated sera by a modified 125I-C1q binding test. Effect of heating on the binding of C1q by immune complexes and application of the test to systemic lupus erythematosus. J Immunol 116:232–235, 1976

    • Search Google Scholar
    • Export Citation

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