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Nephrology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
GN and hypocomplementaemia:1 Primary complement deficiency.2 Cryoglobulinaemia type 2.3 SLE.4 GN (poststreptococcal; mesangiocapillary).5 Endocarditis.6 Shunt nephritis.
Hydrocephalus
Published in Prem Puri, Newborn Surgery, 2017
Jothy Kandasamy, Maggie K. Lee, Mark A. Hughes, Conor L. Mallucci
These may be performed in a similar fashion to VPSs except for the lower incision, which is over the right side of the neck. The objective is for the shunt tip to lie in the superior vena cava or atrium. Open access to the jugular vein can be achieved by exposing the common facial vein. This is tied proximally and held with a stay suture at the venotomy site, and the distal catheter is then fed into the superior vena cava. Throughout the procedure, the anesthetist monitors the electrocardiogram (ECG) for any cardiac alterations or rhythm changes. A purse-string suture is closed around the catheter sufficiently to prevent hemorrhage, but not so tight as to cause obstruction to the catheter. Percutaneous (Seldinger) methods can also be used to enter the jugular or subclavian veins, aided by ultrasound.66–68 Complications include cor pulmonale, catheter emboli, and shunt nephritis.
Prosthetic Device Infections in the Elderly
Published in Thomas T. Yoshikawa, Shobita Rajagopalan, Antibiotic Therapy for Geriatric Patients, 2005
Robert S. Urban, Steven L. Berk
Central nervous system (CNS) shunts are often used in older patients in the treatment of hydrocephalus, including normal pressure hydrocephalus. The neonate and the elderly are at increased risk of shunt infection of the CNS. While the prevalence of shunt infections varies, the infection rate in elderly patients may be as high as 16%. Previous shunt revision and a prior drainage device are risk factors for infection. Both ventricular peritoneal (VP) shunts and ventricular atrial (VA) devices may become infected. Ventricular atrial device infection is more likely to cause infective endocarditis and shunt nephritis, particularly in older patients (2).
Shunt Nephritis: A Case of Mistaken Identity
Published in Acta Clinica Belgica, 2023
Tim Van Damme, Nic Veys, Marijn M. Speeckaert, Sigurd E. Delanghe
Shunt nephritis is a glomerulonephritis caused by persistently infected central nervous system (CNS) shunts that generally recovers following antibacterial therapy and/or shunt removal. First described by Black et al. in 1965, shunt nephritis is now an established, but rare disease entity with approximately 150 reported cases [2,3]. While central nervous system shunt infections are rather common, shunt nephritis remains a rare phenomenon. In 1975, a retrospective case series of 289 children with hydrocephalus reported a shunt infection in 78 (27%) children, but only 8 (3%) of them developed an infection-related glomerulonephritis [4]. In the adult population, the prevalence of central nervous system shunt infections and shunt nephritis is relatively similar and ranges between 4 and 17%, and 0.7 and 2.3%, respectively [4–8]. Furthermore, during the last half-century, ventriculoatrial (VA) shunts have gone out of favor, and the increased use of ventriculoperitoneal (VP) shunts has lowered the occurrence of shunt nephritis even further. Although infection rates are similar between both types of shunts, VP shunt infections disseminate less frequently to the bloodstream and rarely cause nephritis [9,10]. The documented time interval between the implantation or last manipulation of the central nervous system shunt and the onset of shunt nephritis ranges from 0.5 to 21 years [11].