Membranoproliferative Glomerulonephritis in Patients with Chronic Venous Catheters: A Case Report and Literature Review

Chronic indwelling catheters have been reported to be associated with membranoproliferative glomerulonephritis (MPGN) via the activation of the classical complement pathway in association with bacterial infections such as coagulase negative staphylococcus. We herein provide supporting evidence for the direct causal relationship between chronic catheter infections and MPGN via a case of recurrent MPGN associated with recurrent catheter infections used for total parenteral nutrition (TPN) in a man with short gut syndrome. We also present a literature review of similar cases and identify common clinical manifestations that may serve to aid clinicians in the early identification of MPGN associated with infected central venous catheterization or vice versa. The importance of routine monitoring of kidney function and urinalysis among patients with chronic central venous catheterization is highlighted as kidney injury may herald or coincide with overtly infected chronic indwelling central venous catheters. 1. Introduction Membranoproliferative glomerulonephritis (MPGN) is a pattern of disease characterized by the deposition of immunoglobulins, complement factors, or both along capillary walls and within the glomerular mesangium. The classic finding of lobular accentuation of glomerular tufts on light microscopy is attributed to mesangial hypercellularity, endocapillary proliferation, and capillary wall remodeling resulting in the formation of “double contours.” Depositions of the third component of complement (C3) with or without immunoglobulins may be observed on immunofluorescent studies [1]. The underlying etiologies of MPGN comprise a spectrum of conditions including infection, monoclonal gammopathy, autoimmune or rheumatologic disease, and dysregulation of the alternative complement pathway. It is well known that chronic infection from indwelling ventriculosystemic shunts can cause “shunt nephritis”, an entity first reported in 1965 by Black et al. after the placement of a ventriculoatrial shunt for the relief of hydrocephalus in two pediatric patients [2, 3]. Further experiments in animal studies have similarly shown a relation between chronic infections associated with indwelling catheters and MPGN [4, 5]. Although uncommon, there have been few reports of MPGN associated with central venous catheters placed for total parenteral nutrition (TPN) [6]. We herein report a case of recurrent MPGN in association with recurrent coagulase negative Staphylococcus epidermidis Hickman catheter infection, and review the literature for common clinical presentations of