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A Complication in Ventriculoatrial Shunts

Linda Rames, MD; Burton Wise, MD; Joseph R. Goodman, PhD; Carolyn F. Piel, MD

JAMA. 1970;212(10):1671-1677.

Abstract
Three patients had Staphylococcus albus bacteremia as a complication of ventriculoatrial shunts. Each had hematuria, proteinuria, azotemia, acidosis, and anemia; one had the nephrotic syndrome. Two patients' conditions improved after removal of infected shunts; serum complement was reduced in one. Percutaneous renal biopsies showed progressive proliferative and membranous lesions in one patient, proliferative glomerulonephritis in two. Immunofluorescent microscopy showed presence of immunoglobulin in the glomeruli of one and serum complement in two patients. Electron microscopy revealed accumulation of electron-dense, coarsely granular material within the endothelial surface of the basement membrane in all three patients. These findings suggest an immunologic process as the pathophysiologic basis for the renal lesion.

Author Affiliations
From the departments of pediatrics (Drs. Rames and Piel) and neurology (Dr. Wise), University of California and the Veterans Administration Hospital (Dr. Goodman), San Francisco.

Footnotes
Presented in part before the Pediatric Section at the 117th annual convention of the American Medical Association, San Francisco, June 16, 1968.

Reprint requests to University of California Medical Center, Third and Parnassus streets, San Francisco 94122 (Dr. Piel).

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