VERA HERMINA KALIKA KOCH
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Hypertension and cardiovascular disease in developing countries(2013) KOCH, V. H.Hypertension is a major global chronic noncommunicable disease (NCD). One-quarter of the world's adult population has hypertension, and this is likely to increase to 29 % by 2025. Due to epidemiologic shifts, the absolute numbers of patients affected by hypertension in low- and middleincome countries are likely to grow, as increased globalization and economic improvement lead to urbanization and longer life expectancy. Increasing longevity provides longer periods of exposure to the risk factors of cardiovascular disease (CVD), resulting in a greater probability of clinically manifest CVD events. Compounding this high burden of hypertension is a lack of awareness and insufficient treatment in those with hypertension. The survivors of an economic transition period are more likely to present the phenotype of lower birth weight coupled with either stunting or a higher body mass index in childhood or adulthood which appears to be associated with the highest risks of morbid cardiovascular, renal, and metabolic outcomes into adulthood. The combination of population-wide and individual interventions may save millions of lives and considerably reduce human suffering from NCDs. © Springer Science+Business Media New York 2013.
conferenceObject Pediatric peritoneal dialysis in Brazil: document by the Brazilian Society of Nephrology, Brazilian Society of Pediatrics, Brazilian Association of Organ Transplantation, and the Brazilian Association of Dialysis and Transplant Centers.(2023) PENIDO, Maria Goretti Moreira Guimaraes; PALMA, Lilian Monteiro Pereira; BRESOLIN, Nilzete Liberato; TAVARES, Marcelo Sousa; SYLVESTRE, Lucimary Castro; ANDRADE, Olberes Vitor Braga de; BERNARDES, Rejane Paula; BANDEIRA, Maria de Fatima Santos; GARCIA, Clotilde Druck; KOCH, Vera Hermina Kalika; BELANGERO, Vera Maria Santoro; UHLMANN, Anelise; KAUFMAN, Arnauld; ANDRADE, Maria Cristina; SILVA, Roxana Almeida Roque Fontes- First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction(2019) KOSTIC, Dusan; BEOZZO, Glenda Priscila Neves dos Santos; COUTO, Saulo Brasil do; KATO, Andre Henrique Teruaki; LIMA, Laila; PALMEIRA, Patricia; KREBS, Vera Lucia Jornada; BUNDUKI, Victor; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, Marcelo; CARVALHO, Werther Brunow de; KOCH, Vera Hermina KalikaBackground Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. Methods This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinol-binding protein (RBP), cystatin C (mu CyC), and microalbuminuria (ALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Results All urine biomarkers showed significantly higher values at the first month of life (p <= 0.009), while NGAL (p = 0.005), TGF-beta 1 (p<0.001), and mu ALB (p<0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-beta 1 or KIM-1 and NGAL with CyC ([AUC] <= 0.934; sensitivity <= 92.4%; specificity <= 92.8%). Conclusions RBP, NGAL, KIM-1, TGF-beta 1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
- The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants(2019) KOSTIC, D.; BEOZZO, G. P. N. S.; COUTO, S. B. do; KATO, A. H. T.; LIMA, L.; PALMEIRA, P.; KREBS, V. L. J.; BUNDUKI, V; V, R. P. Francisco; ZUGAIB, M.; DENES, F. T.; CARVALHO, W. B. de; KOCH, V. H. K.Introduction The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. Objective The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. Study design The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-beta 1), retinolbinding protein (RBP), and microalbuminuria (mu ALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro (uretero)nephrosis, 13 cases with grade III bilateral hydro (uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 degrees C and thereafter analyzed by quantitative enzymatic immunoassay. Results Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P <= 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P <= 0.043), NGAL (P <= 0.043), KIM-1 (P <= 0.03), and TGF-beta 1 (P <= 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. Discussion To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-beta 1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. Conclusions Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention. [GRAPHICS] .
bookPart Disfunções do trato urinário inferior(2022) CARVALHO, Adrienne Surri Lebl Teixeira de; SAMMOUR, Simone Nascimento Fagundes; KOCH, Vera Hermina Kalika- Comparative role of PET and Kt/V determination in pediatric chronic peritoneal dialysis(2012) WATANABE, Andreia; LANZARINI, Vivian V.; FILHO, Ulisses D.; KOCH, Vera H.Introduction: Nutritional state and growth are considered as prognostic markers of chronic peritoneal dialysis (PD) adequacy in pediatric patients. The euvolemia, blood pressure control, and metabolic and electrolytic equilibrium are parameters to be achieved by PD treatment. Objective: To describe the chronic PD prescription parameters of a cohort of pediatric patients and to compare the obtained hemodynamic, antrophometric and adequacy results with those suggested by the literature. Methods: Retrospective analysis based on clinical records evaluation of 30 pediatric patients undergoing PD for more than 6 months from January 1998 to May 2005. Results: In the present study, 17/30 (56.7%) were boys. Chronic kidney disease was secondary to uropathy in 66.7% of the cases. The infusion volume was > 1,000 ml/m(2) in 9 patients. The peritoneal membrane was characterized as high (27.8%), high-average (33.3%), low-average (22.2%) and low transporter (16.7%). The weekly urea Kt/V was > 2.1 in all the evaluated patients. Blood pressure parameters above the 95th percentile despite the use of antihypertensive medication were observed in 5/30 patients, four of whom with CKD secondary to glomerulopathy. The initial and final Body Mass Index and weight for height ratio were preserved in 83.3% (25/30) patients. Conclusion: Elevated indexes of small solutes removal are easily attained in pediatric PD patients and do not imply optimal clinical management do not imply optimal climanagement.
- Hypertension in the developing world: Epidemiologic transition and health statistics in developing countries(2018) KOCH, V. H.Hypertension is a major global chronic noncommunicable disease (NCD). Due to epidemiologic shifts, the absolute numbers of patients affected by hypertension in low- and middleincome countries are likely to grow, as increased globalization and economic improvement lead to urbanization and longer life expectancy. Increasing longevity provides longer periods of exposure to the risk factors of cardiovascular disease (CVD), resulting in a greater probability of clinically manifesting CVD events. Compounding this high burden of hypertension is a lack of awareness and insufficient treatment in those with hypertension. Additionally, survivors of an economic transition period are more likely to present the phenotype of lower birth weight coupled with either stunting or a higher body mass index in childhood or adulthood, which appears to be associated with the highest risks of morbid cardiovascular, renal, and metabolic outcomes into adulthood. The combination of population-wide and individual interventions may save millions of lives and considerably reduce human suffering from NCDs. © Springer International Publishing AG 2018.
bookPart Hematúria(2022) KOCH, Vera Hermina Kalika- IPEX syndrome with Dent's disease manifestations - Case Report(2013) KOSTIC, Dusan; BRASIL, Saulo Couto; JACOB, Cristina Miuki Abe; SAMPAIO, Magda Carneiro; KOCH, Vera Hermina KalikaObjective: IPEX syndrome, a hereditary (X-linked) immune dysregulation with autoimmune polyendocrinopathy and enteropathy, as the basic manifestations, presents a rare and severe disease. The objective of this case report is to highlight the pleomorphism of the syndrome. Methods: The authors report the case of a male infant, with a family history of three male siblings affected by IPEX syndrome. The patients’ medical records were reviewed in order to describe the case of the youngest one. Results: During the follow-up of the youngest of three siblings, who presented eczema and intestinal manifestation, without compromised pancreatic and thyroid function, different from other two siblings, it was noticed the pattern of Dent’s disease. We registered hypophosphatemia, hypercalciuria, glycosuria, low molecular weight proteinuria and ultrasound revealed second stage bilateral nephrocalcinosis. In this child there was no apparent glomerular involvement, as it was seen in the eldest sibling. Conclusion: Dent’s disease is an X-linked renal proximal tubulopathy associated with mutations in the chloride channel gene CLCN5 (Xp11.22), which is next to FOXP3 gene on the X chromosome (Xp11.23-q13.3). It seems that in this sibling mutations occurred inexons of both of these genes. This case is to remind on pleomorphic potential of mutations that occur near the coding regions of the FOXP3 gene.
conferenceObject Quality of life of patients with MNE and the perception of their caregivers(2016) FAGUNDES, S. N.; LEBL, A. S.; SOSTER, L. M.; KOCH, V. H.