A patient with an infected ventriculoatrial shunt may develop "shunt" nephritis.


Patient selection: ventriculoatrial shunt for drainage of hydrocephalus that is infected with a low-grade bacterial pathogen (Staphylococcus epidermidis, Proprionibacterium acnes, other)


Mechanism: circulating immune complexes


Clinical features:

(1) immune complex glomerulonephritis with hematuria, proteinuria, hypertension and renal dysfunction

(2) variable arthritis

(3) variable purpuric rash (leukocytoclastic vasculitis)

(4) recurrent fever

(5) hepatosplenomegaly

(6) cerebral symptoms (behavioral change, seizures, headache, etc)


Laboratory findings:

(1) anemia

(2) decreased serum C3

(3) variable cryoglobulins

(4) variable ANA and/or rheumatoid factor

(5) elevated serum creatinine

(6) elevated ESR and/or CRP


If the infection is uncontrolled or the diagnosis delayed then the patient can develop renal failure.


If the infection is successfully controlled then long-term complications can be avoided.


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