MELANI RIBEIRO CUSTODIO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
LIM/16 - Laboratório de Fisiopatologia Renal, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- EVALUATION OF BONE MICROARCHITECTURE BY HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY IN PATIENTS WITH CHRONIC KIDNEY DISEASE: COMPARISON WITH TRANSILIAC BONE BIOPSY(2015) MARQUES, Igor; ARAUJO, Maria Julia; GRACIOLLI, Fabiana; REIS, Luciene dos; CUSTODIO, Melani; PEREIRA, Rosa; JAMAL, Sophie; JORGETTI, Vanda; DAVID-NETO, Elias; MOYSES, Rosa
- Persistent hyperparathyroidism as a risk factor for long-term graft failure: the need to discuss indication for parathyroidectomy(2018) ARAUJO, Maria Julia Correia Lima Nepomuceno; RAMALHO, Janaina Almeida Mota; ELIAS, Rosilene Motta; JORGETTI, Vanda; NAHAS, William; CUSTODIO, Melani; MOYSES, Rosa M. A.; DAVID-NETO, EliasBackground: Although a successful kidney transplant (KTx) improves most of the mineral and bone disorders (MBD) produced by chronic kidney disease (CKD), hyperparathyroidism may persist (pHPT). Current guidelines recommend parathyroidectomy if serum parathormone is persistently elevated 1 year after KTx, because pHPT has been recently associated with poor graft outcomes. However, whether patients with pHPT and adequate renal function are at risk for long-term graft failure is unknown. Methods: Longitudinal follow-up of 911 adults submitted to KTx between January 2005 and December 2014, with estimated glomerular filtration rate (eGFR) >= 30 mL/min 1 year after surgery. Clinical and laboratory data were collected from electronic database. Graft failure was defined as return to dialysis. Results: Overall, 62% of the patients were classified as having pHPT 1 year after KTx. After a mean follow-up time of 47 months, there were 59 graft failures (49 in pHPT and 10 in non-pHPT group, P = .003). At last follow-up, death-censored graft survival was lower in the pHPT group (P = .009), even after adjustment for age at KTx, donor age, donor type, acute rejection, parathyroidectomy, and eGFR at 1 year after transplantation (odds ratio [OR] 1.99; 1.004-3.971; P = .049). A PTH of 150 pg/mL at 6 months was the best cutoff to predict pHPT at 1 year (specificity = 92.1%). Conclusion: Having pHPT after a successful KTx increases the long-term risk of death-censored graft failure. This result highlights the need for better recognition and management of CKD-MBD before and during the first year after KTx, and opens a discussion on the more appropriate timing to perform parathyroidectomy.
- Comparison of serum levels with bone content and gene expression indicate a contradictory effect of kidney transplantation on sclerostin(2019) ARAUJO, Maria Julia Correia Lima Nepomuceno; MARQUES, Igor Denizarde Bacelar; GRACIOLLI, Fabiana Giorgetti; FUKUHARA, Luzia; REIS, Luciene Machado dos; CUSTODIO, Melani; JORGETTI, Vanda; ELIAS, Rosilene Mota; DAVID-NETO, Elias; MOYSES, Rosa M. A.In an attempt to clarify the mechanisms of post-transplant bone disease we investigated the bone content and gene expression of several bone-related proteins. After a successful kidney transplant, the content of sclerostin in bone biopsies was found to be increased as measured by immunohistochemistry, multiplex assay, and gene expression despite a concomitant decrease of sclerostin in the serum. The phosphorylation of beta-catenin was increased, confirming Wnt pathway inhibition, an effect accompanied by an increase of the receptor activator of nuclear factor kappa-B ligand (RANKL) and a decrease of osteoprotegerin protein levels in both serum and bone. Thus, changes in circulating biomarkers after kidney transplantation cannot be easily extrapolated to concomitant changes occurring in the bone. Hence, overall treatment decisions post kidney transplant should not be based on serum biochemistry alone.
- Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders(2021) TRUYTS, César; CUSTODIO, Melani; PECOIT-FILHO, Roberto; MORAES, Thyago Proenca de; JORGETTI, VandaAbstract Introduction: Mineral and bone disorders (MBD) are associated with higher mortality in dialysis patients. The main guidelines related to the subject, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO), were elaborated based on published information from hemodialysis participants. The aim of our study was to evaluate the impact of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) (according to guideline ranges from KDOQI and KDIGO) on the cardiovascular mortality of peritoneal dialysis (PD) patients. Methods: We used the BRAZPDII database, an observational multi-centric prospective study, which assessed participants on PD between December 2004 and January 2011. Amongst 9,905 participants included in this database, we analyzed 4424 participants who were on PD for at least 6 months. The appropriate confounding variables were entered into the model. Serum levels of Ca, P, and PTH were the variables of interest for the purposes of the current study. Results: We found a significant association between high P serum levels, categorized by KDOQI and KDIGO (P above 5.5 mg/dL), and cardiovascular survival (p < 0.01). Likewise, a compelling association was found between lower levels of PTH, categorized by guidelines (KDOQI and KDIGO - PTH less than 150 pg/mL, p < 0.01), and cardiovascular survival. Conclusion: In conclusion, levels of P above and PTH below the values proposed by KDOQI and KDIGO were associated with cardiovascular mortality in PD patients.
conferenceObject LIVER, HEART AND BONE: THE PATH OF IRON OVERLOAD IN HEMODIALYSIS PATIENTS(2020) NUNES, Lucas Acatauassu; REIS, Luciene; MACHADO, Hanna; OSORIO, Rosse; MOYSES, Rosa; LEAO-FILHO, Hilton; MOTTA, Rosilene; ROCHITTE, Carlos; JORGETTI, Vanda; CUSTODIO, Melani- BMD in peritoneal dialysis: what BRAZPD can help us understand?(2021) CUSTODIO, Melani