GLOMERULONEPHRITIS AFTER VENTRICULOATRIAL SHUNT

We describe five patients with glomerulonephritis (GN) associated with cerebrospinal fluid shunt insertion to relieve hydrocephalus. A ventr iculo-atrial (V-A) shunt had been placed on average 12.5 years prior t o the diagnosis of nephritis (range 0.5-21 years). Four patients devel oped membranoproliferative glomerulonephritis (MPGN) with associated h ypocomplementaemia. A single patient developed focal proliferative glo merulonephritis. Coagulase-negative staphylococci were cultured in fou r patients, either from blood or from the shunt. Four patients had the ir shunts removed, two of whom also received antibiotics. The other pa tient received antibiotics alone for infective endocarditis due to sta phylococcal bacteraemia which originated in the shunt. All patients ha d substantial renal impairment at the time of diagnosis (GFR, glomerul ar filtration rate, 20-45 ml/min). There was significant improvement i n renal function after appropriate treatment; four of the five patient s doubled their GFRs and two patients regained normal function.