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
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- Digital radiography as an alternative method in the evaluation of bone density in uremic rats(2020) CASTRO, Bárbara Bruna Abreu de; CARMO, Wander Barros; OLIVEIRA, Roberto Sotto Maior Fortes; PETERS, Vera Maria; JORGETTI, Vanda; CUSTODIO, Melani Ribeiro; SANDERS-PINHEIRO, HeladyABSTRACT Introduction: Digital radiography (DRx) may provide a suitable alternative to investigate mineral and bone disorder (MBD) and loss of bone density (BD) in rodent models of chronic kidney disease (CKD). The objective of this study was to use DRx to evaluate BD in CKD rats, and to evaluate the correlation between DRx findings and serum MBD markers and bone histomorphometry. Methods: Uremia was induced by feeding Wistar rats an adenine-enriched diet (0.75% for 4 weeks/0.10% for 3 weeks); outcomes were compared to a control group at experimental weeks 3, 4, and 7. The following biochemical markers were measured: creatinine clearance (CrC), phosphate (P), calcium (Ca), fractional excretion of P (FeP), alkaline phosphatase (ALP), fibroblast growth factor-23 (FGF-23), and parathyroid hormone (PTH). DRx imaging was performed and histomorphometry analysis was conducted using the left femur. Results: As expected, at week 7, uremic rats presented with reduced CrC and higher levels of P, FeP, and ALP compared to controls. DRx confirmed the lower BD in uremic animals (0.57±0.07 vs. 0.68 ± 0.06 a.u.; p = 0.016) compared to controls at the end of week 7, when MBD was more prominent. A severe form of high-turnover bone disease accompanied these biochemical changes. BD measured on DRx correlated to P (r=-0.81; p = 0.002), ALP (r = -0.69, p = 0.01), PTH (r = -0.83, p = 0.01), OS/BS (r = -0.70; p = 0.02), and ObS/BS (r = -0.70; p = 0.02). Conclusion: BD quantified by DRx was associated with the typical complications of MBD in CKD and showed to be viable in the evaluation of bone alterations in CKD.
- Bone disease after transplantation: osteoporosis and fractures risk(2014) KULAK, Carolina A. M.; BORBA, Victoria Z. C.; KULAK JUNIOR, Jaime; CUSTODIO, Melani RibeiroOrgan transplantation is the gold standard therapy for several end-stage diseases. Bone loss is a common complication that occurs in transplant recipients. Osteoporosis and fragility fractures are serious complication, mainly in the first year post transplantation. Many factors contribute to the pathogenesis of bone disease following organ transplantation. This review address the mechanisms of bone loss including the contribution of the immunosuppressive agents as well as the specific features to bone loss after kidney, lung, liver, cardiac and bone marrow transplantation. Prevention and management of bone loss in the transplant recipient should be included in their post transplant follow-up in order to prevent fractures.
- Protocolo clínico e diretrizes terapêuticas para o tratamento do hiperparatireoidismo secundário em pacientes com doença renal crônica(2013) CUSTÓDIO, Melani Ribeiro; CANZIANI, Maria Eugênia Fernandes; MOYSÉS, Rosa Maria Affonso; BARRETO, Fellype Carvalho; NEVES, Carolina Lara; OLIVEIRA, Rodrigo Bueno de; KAROHL, Cristina; SAMPAIO, Elisa de Albuquerque; GUEIROS, José Edevanilson de Barros; JORGETTI, Vanda; CARVALHO, Aluízio Barbosa de
- Mineral and bone disorder after kidney transplantation (KTx)(2021) NEVES, C. L.; MARQUES, I. D. B.; CUSTóDIO, M. R.[No abstract available]
- Adendo das diretrizes brasileiras de prática clínica para o distúrbio mineral e ósseo na doença renal crônica capítulo 2(2012) CARVALHO, Aluízio Barbosa; GUEIROS, Ana Paula Santana; GUEIROS, José Edevanilson de Barros; NEVES, Carolina Lara; KAROHL, Cristina; SAMPAIO, Elisa; CANZIANI, Maria Eugênia; CUSTÓDIO, Melani Ribeiro; MOYSÉS, Rosa Maria Afonso; BARRETO, Fellype; JORGETTI, Vanda
- Registro Brasileiro de Biópsias Ósseas (REBRABO): desenho, banco de dados e metodologia(2014) OLIVEIRA, Rodrigo Bueno de; BARRETO, Fellype Carvalho; CUSTÓDIO, Melani Ribeiro; GUEIROS, José Edvanilson Barros; NEVES, Carolina Lara; KAROHL, Cristina; SAMPAIO, Elisa de Albuquerque; COSTA, Rackel Mota da; CANZIANI, Maria Eugênia Fernandes; MOYSÉS, Rosa Maria Afonso; CARVALHO, Aluízio Barbosa de; JORGETTI, VandaIntroduction: Mineral bone disorder (MBD) is a common condition in chronic kidney disease (CKD) patients and causes significant morbidity and mortality. Data involving prevalence of alterations in bone histological patterns, impact of different treatments and its repercussion in outcomes, such as bone fractures, hospitalization, cardiovascular disease and mortality, are scarce. Data bank registry can be a valuable tool to understand epidemiological aspects of MBD CKD. The Brazilian Registry of Bone Biopsy (REBRABO) will be a national registry, coordinating by the Brazilian Society of Nephrology - Committee of MBD-CKD. Objective: To describe REBRABO's design, elements of data and methodology. Methods: Will be an online national observational and multicentric data registry divided in two phases (retrospective, 1st phase) and prospective (2nd phase), including information from bone tissue histomorphometric analysis and demographics, clinical and laboratorial data from CKD-MBD patients. Results: The REBRABO's first phase will explore data on demographics, clinical, laboratorial and bone histomorphometric analysis data from January/1986 to December/2013. The first Results are expected in early 2015. Conclusion: Studies in the field of CKD-MBD are needed, particularly those analyzing its prevalence, associations between demographic, clinical, histological parameters, and major outcomes. The REBRABO will be a unique retrospective and prospective research platform including bone biopsy data in CKD-MBD patients.
- The deceptive concept of hypoparathyroidism and recurrence after parathyroidectomy in dialysis patients: are we offering a Procrustean bed to some patients?(2016) MONTENEGRO, FABIO LUIZ DE MENEZES; BRESCIA, MARILIA D'ELBOUX GUIMARAES; NASCIMENTO JÚNIOR, CLIMÉRIO PEREIRA; MASSONI NETO, LEDO MAZZEI; ARAP, SÉRGIO SAMIR; SANTOS, STÊNIO ROBERTO CASTRO LIMA; GOLDENSTEIN, PATRÍCIA TASCHNER; BUENO, RODRIGO OLIVEIRA; CUSTODIO, MELANI RIBEIRO; JORGETTI, VANDA; MOYSES, ROSA MARIA AFFONSOABSTRACT Objective: to analyze the frequency of hypoparathyroidism and of its recurrence after parathyroidectomy in dialysis patients according to different existing classifications. Methods: we conducted a retrospective study of 107 consecutive dialysis patients undergoing total parathyroidectomy with immediate autograft in a tertiary hospital from 2006 to 2010. We studied the changes in PTH levels in the postoperative period over time. Were grouped patients according to different PTH levels targets recommended according to the dosage method and by the American and Japanese Nephrology Societies, and by an International Experts Consortium. Results: after parathyroidectomy, there was sustained reduction in serum calcium and phosphatemia. The median value of PTH decreased from 1904pg/ml to 55pg/ml in 12 months. Depending on the considered target level, the proportion of patients below the target ranged between 17% and 87%. On the other hand, the proportion of patients with levels above the target ranged from 3% to 37%. Conclusion: the application of different recommendations for PTH levels after parathyroidectomy in dialysis patients may lead to incorrect classifications of hypoparathyroidism or recurrent hyperparathyroidism and resultin discordant therapeutic conducts.
- 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.
- CKD-MBD in Brazil: the gap between reality and the recommended guidelines(2018) CUSTÓDIO, Melani Ribeiro
- Persistent disorders of mineral metabolism after one year of kidney transplantation(2016) GOMES, Larissa Kruger; CUSTÓDIO, Melani Ribeiro; CONTIERI, Fabiana Loss de Carvalho; RIELLA, Miguel C.; NASCIMENTO, Marcelo Mazza doAbstract Introduction: The persistence of mineral metabolism disorders after renal transplant (RT) appears to possess a negative impact over graft and patient's survival. Objectives: To evaluate the parameters of mineral metabolism and the persistence of hyperparathyroidism (HPT) in transplanted patients for a 12-month period after the procedure. Methods: Retrospective analysis of 41 transplants (18 women- 44%, mean age of 39 ± 15 years) performed in a University Hospital, evaluating changes of calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) and the prevalence of persistent HPT. The patients were divided into two groups accordingly to PTH levels prior to Tx: Group 1 with PTH ≤ 300 pg/mL (n = 21) and Group 2 with PTH > 300 pg/mL (n = 20). The persistency of HPT after transplant was defined as PTH ≥ 100 pg/mL. The evolution of biochemical parameters and the persistency of HPT were analyzed in each group after 1 year of transplant. Results: After a one-year of follow up, 5% of the patients presented hypophosphatemia (p < 2.7 mg/dL), 24% hypercalcemia (Ca > 10.2 mg/dL) and 48% persistency of HPT (PTH ≥ 100 pg/mL). There was a positive correlation between the PTH pre and post Tx (r = 0.42/p = 0.006) and a negative correlation between PTH and Ca pre-Tx (r = -0.45/p = 0.002). However, there was no significant difference among groups 1 and 2 regarding PTH levels pre and post Tx. Conclusion: The findings in this article suggest that mineral metabolism alterations and the persistency of HPT may occur after one year of renal Tx, mainly in patients which present high PTH levels prior toTx.