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2016 ; 9
(ä): 196
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Central venous catheter infection-related glomerulonephritis under long-term
parenteral nutrition: a report of two cases
#MMPMID27036403
Okada M
; Sato M
; Ogura M
; Kamei K
; Matsuoka K
; Ito S
BMC Res Notes
2016[Mar]; 9
(ä): 196
PMID27036403
show ga
BACKGROUND: Advances in long-term parenteral nutrition via indwelling central
venous catheter have improved the quality of life and mortality in patients with
life-threatening gastrointestinal diseases complicated with severely impaired
absorption. However, infection to central venous catheter is still a common and
critical complication for such patients. We encountered two patients under
long-term parenteral nutrition who developed glomerulonephritis associated with
central venous catheter infection. Persistent bacterial infection in indwelling
medical devices placed in the blood-stream such as a ventricular-atrial shunt is
known to cause glomerulonephritis, a condition termed shunt nephritis. We
reported the clinical manifestations, treatment and their pathological findings
in the two patients with glomerulonephritis associated with central venous
catheter infection. CASE PRESENTATION: Both patients suffered from megacystis
microcolon intestinal hypoperistalsis syndrome, a form of pseudo-Hirschsprung's
disease. They had been receiving home parenteral nutrition via central venous
catheter because of severe malabsorption. They presented proteinuria, hematuria,
hypocomplementemia and positive PR3-antineutrophilic cytoplasmic antibody
accompanied by Staphylococcus epidermidis infection in the central venous
catheter. Their renal biopsy revealed membranoproliferative glomerulonephritis
with positive C3 deposition. One of them recovered completely following the
removal of catheter and administration of antibiotics, while another did not
respond to the treatments. We then treated her with methylprednisolone pulse
therapy followed by prednisolone. She responded well, and achieved complete
remission. CONCLUSION: As central venous catheter infection-related
glomerulonephritis has a similar etiology to shunt nephritis, removal of the
catheter and administration of antibiotics is fundamental to the treatment. If a
patient is resistant to such conventional therapy, additional steroid and/or
immunosuppressive agent could be considered. Although the number of patients with
classical shunt nephritis is decreasing since the ventricular-peritoneal shunt
has become became the major procedure for hydrocephalus, central venous catheter
infection-related glomerulonephritis may increase in the future due to a marked
increase in the number of patients receiving long-term parenteral nutrition.
Routine urinalysis should be considered in such patients for early detection of
central venous catheter infection-related glomerulonephritis.