BERNARDO VERGARA REICHERT
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
bookPart Derrame pleural(2017) REICHERT, Bernardo Vergara- Chronic Hyponatremia Due to the Syndrome of Inappropriate Antidiuresis (SIAD) in an Adult Woman with Corpus Callosum Agenesis (CCA)(2018) SILVEIRA, Marcelo Augusto Duarte; SEGURO, Antonio Carlos; SILVA, Jukelson Barbosa da; OLIVEIRA, Marcia Fernanda Arantes de; SEABRA, Victor Faria; REICHERT, Bernardo Vergara; RODRIGUES, Camila Eleuterio; ANDRADE, LuciaObjective: Rare co-existance of disease or pathology Background: Corpus callosum agenesis (CCA) is one of the most common congenital brain abnormalities, and is associated with neurodevelopmental and neuropsychiatric disorders. In CCA, defects in osmoregulation have been reported. This report presents a rare case of chronic hyponatremia associated with the syndrome of inappropriate antidiuresis (SIAD) in a woman with CCA. Case Report: A 41-year-old woman presented to the renal unit with symptomatic hyponatremia. In her past medical history, she had a four-year history of systemic arterial hypertension and Sjogren's syndrome, and a three-year history of systemic lupus erythematosus (SLE), which was treated with cyclophosphamide. She had CCA but with irregular neurological follow-up. During the previous eight years, her plasma sodium levels ranged from between 118-134 mEq/L. On this hospital admission, she had plasma hypo-osmolality, measured in milli-osmoles per kilogram of H2O (mOsm/kg H2O), of 251 mOsm/Kg H2O, and a urinary hyper-osmolality of 545 mOsm/Kg H2O, and increased level of plasma antidiuretic hormone (ADH) (1.8 pg/ml). Bone densitometry was consistent with osteoporosis. The patient remained asymptomatic during her hospital stay. Chronic hyponatremia associated with the SIAD was diagnosed. Water restriction and increased protein intake resulted in a partial improvement in the serum sodium level (128-134 mEq/L). The patient was discharged from the hospital with outpatient follow-up. Conclusions: A rare case of chronic hyponatremia due to the SIAD associated with CCA is reported that demonstrates the importance of correct diagnosis, management, and clinical follow-up of the SIAD, including bone densitometry.
- Cov-hep study: heparin in standard anticoagulation based on citrate for continuous veno-venous hemodialysis in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial(2020) LINS, Paulo Ricardo Gessolo; ALBUQUERQUE, Claudia Coimbra Cesar de; ASSIS, Camila Fernandes; RODRIGUES, Bruna Cristine Duarte; CAMPOS, Beatriz Pinto e Siqueira; VALLE, Eduardo de Oliveira; CABRERA, Carla Paulina Sandoval; GOIS, Jeison de Oliveira; SEGURA, Gabriela Cardoso; STRUFALDI, Fernando Louzada; MAINARDES, Lorena Catelan; RIBEIRO, Rayra Gomes; CORTES, Daniela Del Pilar Via Reque; LUTF, Luciana Gil; OLIVEIRA, Marcia Fernanda Arantes de; SALES, Gabriel Teixeira Montezuma; SMOLENTZOV, Igor; REICHERT, Bernardo Vergara; ANDRADE, Lucia; SEABRA, Victor Faria; RODRIGUES, Camila EleuterioObjectivesThe primary objective is to test if heparin added to a standard regional anticoagulation protocol based on citrate is able to reduce dialysis circuit losses by clotting without increasing the risk of thrombocytopenia or bleeding, in patients with COVID-19 with acute kidney injury requiring dialysis.Trial designRandomized, parallel-group, open-label trial, with two arms (ratio 1:1) comparing different continuous renal replacement therapy anticoagulation strategies.ParticipantsEligibility conditions:All ICU patients of University of Sao Paulo General Hospital (Hospital das Clinicas), Brazil will be screened for eligibility conditions.Adults (> 18 years old) with confirmed COVID-19 and acute kidney injury requiring dialysis with agreement between ICU and nephrology teams for the introduction of renal continuous replacement therapy in daily ICU rounds. Continuous renal replacement therapy will be prescribed by consulting nephrologists based on standard clinical guidelines, including acute kidney injury with hemodynamic instability plus hyperkalemia, severe acidosis, volume overload, respiratory distress, multiorgan failure or some combination of these factors.Data Collection:Patients demographics and associated clinical data and comorbidities will be recorded at ICU entry. Demographic information will include the patient's age, sex, and admission dates. Clinical data comprise comorbidities, APACHE 2, SAPS 3, need for mechanical ventilation, and use of vasopressor drugs. Physiological data collected by the day of CRRT start will be vital signs, the arterial oxygen tension/fraction of inspired oxygen (PaO2/FiO2) index, and serum creatinine, blood urea nitrogen, bilirubin, hemoglobin, hematocrit, platelets, white blood cell count levels and Peak D-dimer levels.Patients will be analyzed for the first 72h of CRRT, and they will be evaluated regarding clinical variables, filter patency and any adverse events that could be related to the anticoagulation choice, as bleeding (mild or major) or low platelets counts (<100.000 ui/uL) during treatment period. Mild and major bleeding will be defined by hemorrhagic event without clinical impact or hemoglobin (Hb) fall lesser than 1g/dL and hemorrhagic event with clinical impact or Hb fall higher than 1g/dL, respectively.Exclusion criteria:Hypersensitivity to any of the substances going to be used in the study (Citric acid dextrosol 2.2% and unfractionated heparin); Previous diagnosis of coagulopathy or thrombophilia; Contraindication to the use of unfractionated heparin; Risk of citrate poisoning - (Lactate> 30 mg/dL, international normalized ratio > 2.5, Total bilirubin> 15 mg/dL); Pregnancy; Patients unlikely to survive for more than 24 hours.The trial is being undertaken at the University of Sao Paulo General Hospital (Hospital das Clinicas), Brazil.Intervention and comparatorGroup A (control) - Patients on continuous renal replacement therapy (blood flow 150 ml/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/LGroup B (experiment): Patients on continuous hemodialysis (blood flow 150 mL/min, dose of 30 mL/Kg/h) receiving anticoagulation with sodium citrate at 4 mmol/L associated with unfractionated heparin at 10 U/Kg/h. Main outcomesThe percentage of clotted dialyzers within 72 hours in each of the studied groups (Primary outcome)Secondary outcomes: Number of dialyzers used in the first 72 hours of dialysis protocol, Mortality in the first 72 h of dialysis protocol, Bleeding events (Major or minor) in the first 72 h of dialysis protocol, Thrombocytopenia (less than 50.000 platelets) proportion in the first 72 h of dialysis protocol, Dialysis efficiency (Urea sieving) - variation in urea sieving between the first, second and third days of dialysis protocol, Continuous renal replacement therapy pressures (Arterial, Venous, dialysate and pre-filter pressure) in the first 72 h of dialysis protocol, in-hospital mortality.RandomizationRedCap -> randomization - 2 blocks randomization by D-dimer level (5000ng/dL cut-off) and catheter site (Right Internal Jugular versus other sites) with 1:1 allocation ratio.Blinding (masking)No blinding - Open label formatNumbers to be randomized (sample size)Total number of patients 90 (45 per group)Trial StatusTrial version 2.0 - ongoing recruitment.First recruitment: June 29, 2020Estimated date for last recruitment: December 31, 2020Trial registrationResponsible Party: University of Sao Paulo General Hospital (Hospital das Clinicas)ClinicalTrials.gov Identifier: NCT04487990, registered July 27, 2020, ReBec www.ensaiosclinicos.gov.br/rg/RBR-45kf9p/Other Study ID Numbers: U1111-1252-0194Full protocolThe full protocol is attached as an additional file, accessible from the Trials website (Additional file 1) In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
- Is there a link between COVID-19 and adrenal insufficiency?(2023) ALMEIDA, Carlos Augusto Pereira de; GUIMARAES, Marilia Rodovalho; OLIVEIRA, Marcia Fernanda Arantes de; SEABRA, Victor; SMOLENTZOV, Igor; REICHERT, Bernardo Vergara; LINS, Paulo Ricardo Gessolo; RODRIGUES, Camila Eleuterio; ANDRADE, Lucia da Conceicao
- Atypical presentation of acute post-infectious glomerulonephritis in patients with sickle cell disease: report of two cases(2020) NEVES, Precil Diego Miranda de Menezes; REICHERT, Bernardo Vergara; BRIDI, Ramaiane Aparecida; YU, Luis; DIAS, Cristiane Bitencourt; PINHEIRO, Rafaela Brito Bezerra; TESTAGROSSA, Leonardo de Abreu; CAVALCANTE, Livia Barreira; MALHEIROS, Denise Maria Avancini Costa; JORGE, Lecticia Barbosa; WORONIK, ViktoriaBackgroundSickle cell disease (SCD) is a highly prevalent genetic disease worldwide. In the natural evolution of SCD, glomerular lesions can develop, presenting histopathological patterns of segmental or focal membranoproliferative glomerulosclerosis, with or without thrombotic microangiopathy. We report two cases of acute post-infectious glomerulonephritis (APIGN), with atypical presentations, in patients with SCD.Case presentationCase 1: An 18-year-old female with SCD presented with a 21-day history of progressive oedema, accompanied by dyspnoea, productive cough, fever, and chest pain. Blood tests showed the following: haemoglobin 6.1g/dl; leucocytes 18,820 cells/mm(3); and creatinine 0.49mg/dl. A urine sample evidenced leucocyturia and haematuria. The 24-h proteinuria was 8.99g, serum albumin level was 1.2g/dl, low serum C3 levels and high levels of anti-streptolysin O. Renal biopsy was consistent with APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving to reversal of the renal alterations. Case 2: A 12-year-old male with SCD presented with a 20-day history of a non-productive cough and progressive oedema, together with hypertension. The serum creatinine concentration was 0.48mg/dl. A urine sample evidenced leukocyturia and haematuria. The 24-h proteinuria was 12.5g, and the serum albumin level was 2.6g/dl. The levels of C3 and C4 were normal. Renal biopsy revealed APIGN. The patient was treated with diuretic and anti-proteinuric agents, subsequently evolving reversal of the renal alterations.ConclusionsThe presentation of the two cases reported here are not typical of SCD-related kidney injury. Analysis of the renal biopsy specimens elucidated the diagnosis, affecting the prognosis, because that of APIGN is highly favourable, unlike that of nephrotic syndrome associated with SCD glomerulopathy.
- Continuous renal replacement therapy in COVID-19-associated AKI: adding heparin to citrate to extend filter life-a retrospective cohort study(2021) VALLE, Eduardo de Oliveira; CABRERA, Carla Paulina Sandoval; ALBUQUERQUE, Claudia Coimbra Cesar de; SILVA, Giovanio Vieira da; OLIVEIRA, Marcia Fernanda Arantes de; SALES, Gabriel Teixeira Montezuma; SMOLENTZOV, Igor; REICHERT, Bernardo Vergara; ANDRADE, Lucia; SEABRA, Victor Faria; LINS, Paulo Ricardo Gessolo; RODRIGUES, Camila EleuterioBackground: Coronavirus disease 2019 (COVID-19) may predispose patients to thrombotic events. The best anticoagulation strategy for continuous renal replacement therapy (CRRT) in such patients is still under debate. The purpose of this study was to evaluate the impact that different anticoagulation protocols have on filter clotting risk. Methods: This was a retrospective observational study comparing two different anticoagulation strategies (citrate only and citrate plus intravenous infusion of unfractionated heparin) in patients with acute kidney injury (AKI), associated or not with COVID-19 (COV + AKI and COV - AKI, respectively), who were submitted to CRRT. Filter clotting risks were compared among groups. Results: Between January 2019 and July 2020, 238 patients were evaluated: 188 in the COV + AKI group and 50 in the COV - AKI group. Filter clotting during the first filter use occurred in 111 patients (46.6%). Heparin use conferred protection against filter clotting (HR = 0.37, 95% CI 0.25-0.55), resulting in longer filter survival. Bleeding events and the need for blood transfusion were similar between the citrate only and citrate plus unfractionated heparin strategies. In-hospital mortality was higher among the COV + AKI patients than among the COV - AKI patients, although it was similar between the COV + AKI patients who received heparin and those who did not. Filter clotting was more common in patients with D-dimer levels above the median (5990 ng/ml). In the multivariate analysis, heparin was associated with a lower risk of filter clotting (HR = 0.28, 95% CI 0.18-0.43), whereas an elevated D-dimer level and high hemoglobin were found to be risk factors for circuit clotting. A diagnosis of COVID-19 was marginally associated with an increased risk of circuit clotting (HR = 2.15, 95% CI 0.99-4.68). Conclusions: In COV + AKI patients, adding systemic heparin to standard regional citrate anticoagulation may prolong CRRT filter patency by reducing clotting risk with a low risk of complications.
- Risk Factors for Acute Kidney Injury and Death in Patients Infected With the Yellow Fever Virus During the 2018 Outbreak in Sao Paulo, Brazil(2022) ARANTES, Marcia Fernanda; SEABRA, Victor Faria; LINS, Paulo Ricardo Gessolo; RODRIGUES, Camila Eleuterio; REICHERT, Bernardo Vergara; SILVEIRA, Marcelo Augusto Duarte; LI, Ho Yeh; MALBOUISSON, Luiz Marcelo; ANDRADE, LuciaIntroduction: There have been few studies investigating acute kidney injury (AKI) in patients with yellow fever (YF). The objective of this study was to identify the risk factors for AKI and death in such patients. Methods: We evaluated 95 consecutive critically ill adult patients with the sylvatic form of YF, as confirmed by reverse-transcriptase polymerase chain reaction, in Brazil. The outcome measures were AKI (as defined by Kidney Disease: Improving Global Outcomes [KDIGO] criteria) and in-hospital death. Results: Of the 95 patients, 73 (76.8%) had AKI and 59 (62.1%) died from it. A total of 70 patients (73.7%) required dialysis because of AKI. After adjusting for age, sex, and the Simplified Acute Physiology Score 3 (SAPS 3), we found that elevated fractional excretion of sodium and requiring dialysis were independent risk factors for in-hospital mortality and that proteinuria correlated with AKI-associated mortality. Conclusion: Our findings indicate that, in patients with sylvatic YF, AKI is common and is associated with significant mortality. The data presented here could prove useful for improving understanding of the pathogenesis of AKI in YF and informing decisions regarding the care of the affected patients.
bookPart Derrame pleural(2015) REICHERT, Bernardo VergarabookPart Derrame pleural(2023) REICHERT, Bernardo VergaraconferenceObject Which Post-Transplant Complications Are More Common in Elderly Renal Recipients?(2016) AGENA, F.; PAULA, F.; REICHERT, B.; NEVES, P.; PIOVESAN, A.; NAHAS, W.; DAVID-NETO, E.