Biomedical subjects

D M Burstein

Publications and source records attributed to D M Burstein.

4 recordsLinked to original sources

PubMed1993

Membranous glomerulonephritis and malignancy.

The purpose of this review is to enhance the clinical awareness of the association between membranous glomerulonephritis and neoplasia. Controversy has persisted that has tended to minimize this association, therefore, we report our experience to shed some light on this controversy as well as to make diagnostic recommendations. One hundred seven adult patients with biopsy-proven membranous glomerulonephritis were selected for review. Twenty of these patients had a known secondary cause of membranous glomerulonephritis other than malignancy. Data were collected retrospectively on all these patients and nine were found who had or developed malignancy associated with membranous glomerulonephritis. Clinical data were analyzed to ascertain the onset of renal disease in relation to the malignancy as well as to determine the ultimate patient and renal outcome after treatment of the neoplasm. Of the 87 patients with presumed idiopathic membranous glomerulonephritis, nine (10.3%) had or developed a malignancy associated with their renal disease. The membranous glomerulonephritis was seen in patients with various solid tumors as well as hematologic malignancies. All patients presented with nephrotic-range proteinuria. Proteinuria manifested itself prior to or concomitantly with the diagnosis of the neoplasm in approximately 80% of cases. Follow-up data were available on seven patients: complete remission of proteinuria was seen in two patients associated with treatment of their tumors, one patient developed end-stage renal disease, and the remaining four patients had persistent proteinuria associated with tumor recurrence or metastasis. There appears to be a clear association between membranous glomerulonephritis and neoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1993

The use of the automatic core biopsy system in percutaneous renal biopsies: a comparative study.

We describe our experience with the use of the automatic core biopsy system for percutaneous renal biopsy and compare this with our experience with a standard biopsy needle. Three hundred twenty-three biopsies were performed between June 1983 and January 1993. From June 1983 through October 1990, 232 biopsies were performed with the use of a standard biopsy needle (Tru-cut needle; Travenol Laboratories, Deerfield, IL) and from November 1990 through January 1993, 91 biopsies were conducted with the use of the automatic core biopsy system (Biopty gun and needle; C.R. Bard, Inc, Covington, GA). Biopsies performed prior to January 1990 were reviewed retrospectively, while those performed after January 1990 were reviewed in a prospective manner. The primary indications for renal biopsy were to evaluate proteinuria (48.9%) and renal manifestations of systemic lupus erythematosus (26.0%). The two groups of patients were similar with respect to sex, age, serum creatinine, and coagulation parameters. Material for light microscopy, immunofluorescence microscopy, and electron microscopy was obtained in 98.9%, 98.9%, and 97.8% of cases, respectively, with the use of the automatic core biopsy system, and these values did not differ significantly from those with the use of the standard needle (99.6%, 96.1%, and 97.8%). Significantly more glomeruli were obtained by light microscopy per biopsy specimen with the use of the automatic core biopsy system versus the standard needle (28 +/- 15 and 21 +/- 13, respectively; P < 0.0001). Complications were assessed and separated by severity. Total complications were observed in 13 patients (14.3%) with the automatic core device and in 31 patients (13.4%) with the standard needle.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Membranoproliferative glomerulonephritis associated with hepatitis C virus infection.

The hepatitis C virus genome has been recently sequenced and cloned, allowing the identification of patients exposed to this virus, which is now felt to be the principal cause of "non-A, non-B" hepatitis. The hepatitis B virus has long been implicated in the pathogenesis of several glomerulopathies including membranoproliferative glomerulonephritis, mixed cryoglobulinemia, and membranous glomerulonephritis. Several authors have recently reported an association between hepatitis C virus infection and glomerular disease. The case of a patient with chronic hepatitis C virus infection who developed the nephrotic syndrome 3 months after liver transplantation is described. Serologic testing was significant for an elevated rheumatoid factor, circulating cryoglobulins, and a mildly depressed C4 level. Hepatitis C virus antibody and viral RNA (by polymerase chain reaction) were present in both the serum and cryoglobulin fraction. A renal biopsy demonstrated membranoproliferative glomerulonephritis. It is believed that persistent infection with the hepatitis C virus is responsible for an immune complex-mediated glomerulonephritis in this patient. Because hepatitis C has now been pathogenetically linked to several glomerulopathies, testing for this virus should be considered in the serologic work-up of the patient with glomerulonephritis.

Aged↗

PubMed1991

Percutaneous renal biopsy with the use of real-time ultrasound.

We describe our experience with real-time ultrasound as a localization and guidance tool for percutaneous renal biopsy. Two hundred biopsies performed between June 1983 and January 1990 were reviewed retrospectively. Nephrology fellows performed 83.5% of the biopsies. The average age of the patients was 43 +/- 17 years (range 6-80) and renal insufficiency (serum creatinine greater than or equal to 1.3 mg, %) was present in approximately 60% of patients biopsied. Primary indications for biopsy were to evaluate proteinuria (46.5%) and renal manifestation of systemic lupus erythematosus (24%). Material for light microscopy, immunofluorescence, and electron microscopy was obtained in 99.5, 95.0 and 98.0% of cases, respectively. Adequate tissue for histologic diagnosis was obtained in 97.5% of patients. Primary diagnosis was glomerulonephritis in 77.9% of cases. Complications were assessed and separated by severity. Total complications were observed in 13.7% of patients with 8.1% of these being minor complications (not requiring blood transfusion) and 5.6% being major complications which required blood transfusions. Bleeding complications requiring massive blood transfusion and/or therapeutic radiologic intervention were seen in 1.5% of patients. We could find no significant difference with respect to age, serum creatinine, or coagulation parameters between patients with or without complications due to percutaneous renal biopsy. We conclude that real-time ultrasound is a safe, accurate method in localizing the kidney for percutaneous renal biopsy. However, patients must still be observed carefully post biopsy for potential complications.

Adult↗