VERA LUCIA JORNADA KREBS
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
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
12 resultados
Resultados de Busca
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- 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.
- Type II and III Selective Fetal Growth Restriction: Perinatal Outcomes of Expectant Management and Laser Ablation of Placental Vessels(2018) MIYADAHIRA, Mariana Yumi; BRIZOT, Maria de Lourdes; CARVALHO, Mario Henrique Burlacchini de; BIANCOLIN, Sckarlet Ernandes; MACHADO, Rita de Cassia Alam; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana Pulcineli Vieira; PERALTA, Cleisson Fabio AndrioliOBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed ""a'' wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.
- Nonimmune fetal ascites: identification of ultrasound findings predictive of perinatal death(2016) BACCEGA, Felipe; BRIZOT, Maria de Lourdes; KREBS, Vera Lucia Jornada; FRANCISCO, Rossana Pulcineli Vieira; ZUGAIB, MarceloAim: To determine the ultrasonographic findings that predict death in fetal ascites. Methods: This was a retrospective cohort study involving pregnancies with ultrasonographic findings related to fetal ascites. The inclusion criteria were as follows: single pregnancy with a live fetus; ultrasound findings of ascites; ascites unrelated to maternal fetal alloimmunization; and pregnancy follow-up at our institution. The chi(2)-test was used to evaluate the association of ultrasound findings and death. Multiple logistic regression analysis was performed to determine the ultrasound findings that are predictive of death prior to hospital discharge. Results: A total of 154 pregnancies were included in the study. In 8 (5.19%) cases, ascites was an isolated finding, and in 146 cases, other alterations were observed during the ultrasound evaluation. Death before hospital discharge occurred in 117 cases (76.00%). The following ultrasonographic findings were significantly associated with death: gestational age at diagnosis <24 weeks (P < 0.0001); stable/progressive ascites evolution (P = 0.004); the presence of hydrops (P < 0.0001); and the presence of cystic hygroma (P < 0.0001). The presence of hydrops, the presence of respiratory tract malformations, and stable/progressive ascites evolution were significantly associated with the prediction of death. Conclusions: Based on ultrasound examination, the presence of hydrops, malformation of the respiratory tract, and stable/progressive evolution of ascites increase the chances of death in cases of fetal ascites.
- OBSTETRIC AND PERINATAL OUTCOMES IN PREGNANT WOMEN WITH PERINATALLY ACQUIRED HIV-INFECTION-PRELIMINARY RESULTS(2017) OSMUNDO JUNIOR, Gilmar de Souza; RODRIGUES, Agatha Sacramento; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira
- Pregnancy outcomes in severe polyhydramnios: no increase in risk in patients needing amnioreduction for maternal pain or respiratory distress(2016) KLEINE, Rodolpho Truffa; BERNARDES, Lisandra Stein; CARVALHO, Mariana Azevedo; CARVALHO, Mario Henrique Burlachini de; KREBS, Vera Lucia; FRANCISCO, Rossana Pulcineli VieiraIntroduction: Polyhydramnios is a common complication of fetal malformations and has been described to have high risk of pregnancy complications such as prematurity and placental abruption. In a subgroup of women severe polyhydramnios may lead to maternal dyspnea or untreatable pain, and amnioreduction is the procedure indicated to relieve those symptoms. There is a lack of information concerning the increase in the risk for the pregnancy when the procedure is indicated. Therefore, this study sought to evaluate the risk of complications in pregnancies with severe polyhydramnios that needed amnioreduction in relation to the basal risk for the pregnancy of having polyhydramnios without the need for the procedure.Materials and methods: Patients with singleton pregnancies and severe polyhydramnios followed in our fetal medicine center were evaluated retrospectively. Pregnancy complications (prematurity rate, fetal death, premature rupture of membranes, placental abruption and chorioamnionitis) were studied in the group of patients needing the procedure and their risk was compared to the risk of having a pregnancy with severe polyhydramnios but with no need for the procedure.Results: One hundred and thirty-five patients were evaluated. Forty-four patients (32.6%) needed amnioreduction. There was no increase in the risk of having complications when the procedure was needed OR=1.4 (CI 0.46-1.26).Conclusion: Amnioreduction performed to relieve maternal symptoms did not statistically increase the risk of pregnancy complications with severe polyhydramnios in single pregnancies.
bookPart Manejo das gestantes e recém-nascidos e COVID-19(2021) FRANCISCO, Rossana Pulcineli Vieira; KREBS, Vera Lúcia Jornada- Kidney impairment in fetal growth restriction: three-dimensional evaluation of volume and vascularization(2020) SENRA, Janaina Campos; YOSHIZAKI, Carlos Tadashi; DORO, Giovana Farina; RUANO, Rodrigo; GIBELLI, Maria Augusta Bento Cicaroni; RODRIGUES, Agatha Sacramento; KOCH, Vera Hermina Kalika; KREBS, Vera Lucia Jornada; ZUGAIB, Marcelo; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinObjectives Renal development is impaired in fetal growth restriction (FGR). Renal size can be considered a surrogate of renal function in childhood, and could be impaired in that condition. Our aim was to evaluate the ratio of total renal volume, measured by three-dimensional ultrasound, to estimated fetal weight (TRV/EFW) among fetuses with and without growth restriction. Furthermore, we correlated TRV/EFW with fetal Doppler velocimetry and renal vascularization indexes and evaluated the association of renal volume and vascular parameters with adverse neonatal events in growth-restricted fetuses. Methods In a retrospective cohort, TRV and renal vascularization of growth-restricted and normal fetuses were evaluated by three-dimensional ultrasonography and VOCAL technique. Independent samples t-tests and Mann-Whitney test were used for comparisons between groups. Logistic regression model was applied to evaluate the association between renal characteristics and adverse neonatal events. Results Seventy-one growth-restricted fetuses were compared to 194 controls. The TRV/EFW was lower in the growth-restricted group (P < .001). In our sample, this ratio did not correlate with Doppler velocimetry parameters, renal vascular indexes or any adverse neonatal events. Conclusion The TRV/EFW ratio is decreased in FGR. Further studies are needed to investigate the association of this ratio with long-term renal outcomes.
- An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis(2018) SENRA, Janaina Campos; CARVALHO, Mariana Azevedo; RODRIGUES, Agatha Sacramento; KREBS, Vera Lucia Jornada; GIBELLI, Maria Augusta Bento Cicaroni; FRANCISCO, Rossana Pulcineli Vieira; BERNARDES, Lisandra SteinSince studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.
- Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases(2016) LOPES, Lilian Maria; CARRILHO, Milene Carvalho; FRANCISCO, Rossana Pulcineli Vieira; LOPES, Marco Antonio Borges; KREBS, Vera Lucia Jornada; ZUGAIB, MarceloObjective: The aim of this study was to analyze the causes and perinatal outcome related to fetal ductus arteriosus constriction or closure at a single center over a 26-year period.Methods: This was a retrospective analysis of 45 consecutive cases of constriction (n=41) and closure (n=4) from 1987 through 2013. Patients were divided into Group A (maternal use of non-steroidal anti-inflammatory drugs (NSAID), n=29), Group B (idiopathic, n=8), and Group C (other drugs not previously described, n=8).Results: The median gestational age at diagnosis was 34 weeks (range, 27-38), mean systolic and diastolic velocity in the ductus arteriosus was 2.010.66m/s and 0.71 +/- 0.46m/s, respectively. Among the 29 cases of NSAIDs, 27.5% (8/29) have taken a single day use and 75% multiple days/doses. Right ventricular dilatation was present in 82.2% of the fetuses, tricuspid insufficiency in 86.6%, and heart failure in 22.2%. Neonatal persistent pulmonary hypertension occurred in 17.7% of the patients. Late follow-up showed all 43 survivors alive and healthy with only two deaths from unrelated causes.Conclusions: The results of this study indicate that clinically significant ductal constriction may follow maternal exposure to single doses of NSAIDs. Unknown causes or other new substances were also described, such as naphazoline, fluoxetine, isoxsuprine, caffeine and pesticides. Echocardiographic diagnosis of ductal constriction led to an active medical approach that resulted in low morbidity of this group of patients.
- Intrauterine growth restriction in monochorionic-diamniotic twins(2014) MACHADO, Rita de Cassia Alam; BRIZOT, Maria de Lourdes; MIYADAHIRA, Seizo; FRANCISCO, Rossana Pulcineli Vieira; KREBS, Vera Lucia Jornada; ZUGAIB, MarceloObjective: to evaluate neonatal morbidity and mortality in monochorionic-diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR) and non-selective intrauterine growth resctriction (nsIUGR). Methods: neonatal morbidity parameters and mortality were analyzed in 34 twins with IUGR (< 10th percentile on twins' growth charts): 18 with sIUGR and 16 with nsIUGR. The sIUGR group was made up of 18 pregnancies in which growth was restricted in only one fetus (n = 18). The nsIUGR group was composed of 8 pregnancies in which both fetuses presented restricted growth (n = 16). Cases of twin-to-twin transfusion syndrome and fetal malformation were not included in the study. Results: the MCDA twin pregnancies with sIUGR had a higher rate of orotracheal intubation (p = 0.001) and mechanical ventilation (p = 0.0006), as well as longer than average fasting time (p = 0.014) compared to those in which the fetuses had nsIUGR. A higher incidence was also observed of types II and III umbilical artery Doppler velocimetry patterns in the sIUGR cases (p = 0.002). There was no significant difference between the two groups as to mortality during pregnancy and the neonatal period (p = 0.09). Conclusion: in MCDA twin pregnancies, sIUGR presents more severe umbilical artery Doppler velocimetry abnormalities and worse morbidity than nsIUGR.