脳室心房シャント術に伴う腎炎の1例

A Case of Glomerulonephritis Associated with Ventriculo-Atrial Shunt

Ⅰ．はじめに

　脳室心房シャント術（VAシャント）・脳室腹腔シャント術（VPシャント）に伴う稀な合併症として，シャント腎炎と称される糸球体腎炎が知られている．今回われわれは，VAシャント術2年後にシャント腎炎を発症し，シャント抜去により治癒した1例を経験したため，若干の文献的考察を加えて報告する．

　Nephritis associated with a chronically infected ventriculo-atrial (VA) or ventriculo-peritoneal (VP) shunt is known as shunt nephritis. A 60-year-old woman who had a VA shunt implanted for hydrocephalus began to show intermittent low-grade fever of an unknown origin,as well as hypertension and lower leg edema. Laboratory findings showed renal insufficiency with proteinuria,and a percutaneous renal biopsy was performed. Light microscopy revealed findings of membranoproliferative glomerulonephritis. Shunt nephritis was suspected. The VA shunt was removed and the VP shunt was replaced subsequently. Signs of renal impairment were recovered after surgery. However,a new VA shunt was implanted because of a shunt malfunction.

　Shunt nephritis is a rare complication associated with shunt system implantation. It can be treated successfully by removing the shunt system immediately. It should be considered that shunts,especially VA shunts,always carry a risk of nephritis.