ETIENNE MARIA VASCONCELLOS DE MACEDO
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- Timing of Dialysis Initiation in Acute Kidney Injury and Acute-On-Chronic Renal Failure(2013) MACEDO, Etienne; MEHTA, Ravindra L.The decision to provide dialytic support and choosing the ideal moment to initiate therapy are common impasses for physicians treating patients with acute kidney injury (AKI). Although renal replacement therapy (RRT) has been extensively used in clinical practice for more than 30years, there is a paucity of evidence to guide clinicians on the optimal utilization of RRT in AKI. In the absence of traditional or urgent indications, there is no consensus on whether dialysis should be offered and when it should be started. The lack of agreed-upon parameters to guide the decision, the fear of the risk of the procedure, and the possible contribution to worse prognosis with RRT have resulted in a considerable variation in practice among physicians and centers. In this review, we summarize the evidence evaluating time of initiation of RRT and discuss possible approaches for future trials in addressing this issue.
- Rationale and Design of the Genetic Contribution to Drug Induced Renal Injury (DIRECT) Study(2016) AWDISHU, Linda; NIEVERGELT, Caroline M.; DAVENPORT, Andrew; MURRAY, Patrick T.; MACEDO, Etienne; CERDA, Jorge; CHAKARAVARTHI, Raj; RAO, Satish P. Ramachandra; HOLDEN, Arthur; GOLDSTEIN, Stuart L.; MEHTA, Ravindra L.Introduction: Nephrotoxicity from drugs accounts for 18% to 27% of cases of acute kidney injury. Determining a genetic predisposition maypotentially be important in minimizing risk. The aims of this study are as follows: to determine whether a genetic predisposition exists for the development of drug-induced kidney disease (DIKD), using genome-wide association and whole-genome sequencing studies; to describe the frequency, course, risk factors, resolution and outcomes of DIKD cases; to investigate the role of ethnic/racial variability in the genetics of DIKD; and to explore the use of different tools establishing causality of DIKD. Methods: A total of 800 patients will be enrolled worldwide and blood samples for DNA collected. Data on the patient risk factors, vital signs, laboratory parameters, drug exposure, and DIKD course will be recorded. A panel of nephrologists will adjudicate all cases. Genome-wide association studies will be conducted using population controlsmatched on biogeographic ancestry to determine whether there is agenetic predisposition to DIKD. The primary endpoint is the identification of specific drug-related polymorphisms associated with DIKD. Secondary endpoints include the following: frequency of DIKD by causal drug and drug combinations; DIKD genetic variability; exploration of causality assessment tools; risk factor identification; description of the course of DIKD, including mortality and dialysis dependency at hospital discharge and 28 and 90 days post-event. Results: Data are currently being analyzed. Results are pending. Discussion: The Genetic Contribution to Drug Induced Renal Injury (DIRECT) study will be the first observational cohort study to investigate the genetic determinants of DIKD. If the trial is positive, its findings will potentially translate into safer patient outcomes, by genotypic individualization of therapy and minimization of harm.
conferenceObject A CLINICAL SCORE TO PREDICT MORTALITY IN SEPTIC AKI REQUIRING CONTINUOUS RENAL REPLACEMENT THERAPY: THE HELENICC SCORE(2014) PASSOS, R.; DUTRA, F.; BATISTA, P.; MACEDO, E.; CORREIA, L.; DUTRA, M.- Targeting Recovery from Acute Kidney Injury: Incidence and Prevalence of Recovery(2014) MACEDO, Etienne; MEHTA, Ravindra L.Since the creation of Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Renal Disease (RIFLE) criteria in the last 10 years, the use of a standardized definition of acute kidney injury (AKI) has made it possible for epidemiologic studies to document the increasing incidence of AKI, especially in the critical care setting [1]. In addition, several studies applying the criteria of RIFLE, Acute Kidney Injury Network, and, more recently, the Kidney Disease: Improving Global Outcome, were able to establish the association of severity of AKI with adverse clinical outcomes, including the development of chronic kidney disease (CKD) and end-stage renal disease (ESRD) [2-4]. Although, until recently, it was thought that survivors from an AKI episode frequently recover kidney function, cumulative observational data over the past decade have confirmed the association of AKI with the increased risk for permanent kidney damage, with subsequent development of CKD [5]. The epidemiological studies that we will present and discuss in this review confirm and clarify the association of AKI with the development of CKD and ESRD [6-8]. (C) 2014 S. Karger AG, Basel
bookPart Métodos contínuos em UTI(2016) RODRIGUES, Camila Eleutério; MACEDO, Etienne- Comprehensive Assessment of Kidney Health in Acute Kidney Injury: Can It Be Achieved?(2019) MACEDO, Etienne; LIMA, CamilaAcute kidney injury (AKI) is a frequent event in hospitalized patients, with an incidence that continues to rise, reaching as high as 70-80% in intensive care settings. The need for dialysis and progression to end-stage kidney disease (ESKD) after an episode of AKI is relatively low, from 5 to 20%. However, it is now recognized that patients with AKI may have very different kidney outcomes, varying from complete recovery, incipient chronic kidney disease (CKD), to progression to ESKD. Recent studies have shown that even mild AKI episodes can be associated with a 90% increased risk of developing CKD during long-term follow-up. There is a significant need to focus our efforts on factors that could mitigate the progression of kidney dysfunction and ultimately improve outcomes from AKI. The first step toward this goal encompasses a better understanding of tubular and glomerular alterations during and following an AKI episode. Our current approach, based solely on glomerular filtration rate (GFR), is flawed, since the loss of kidney function does not correspond to the degree of decline in estimated GFR (eGFR), and eGFR does not reflect tubular function. Changes in tubular concentration, reabsorptive and secretory capacity are recognized in AKI; however, they have not been incorporated in clinical assessments of overall kidney function. Here we review a few candidates to assess glomerular filtration/permeability, tubular dysfunction, and injury and how we expect these markers to alter during the development and recovery phase of AKI.
- Phenotype standardization for drug-induced kidney disease(2015) MEHTA, Ravindra L.; AWDISHU, Linda; DAVENPORT, Andrew; MURRAY, Patrick T.; MACEDO, Etienne; CERDA, Jorge; CHAKARAVARTHI, Raj; HOLDEN, Arthur L.; GOLDSTEIN, Stuart L.Drug-induced kidney disease is a frequent cause of renal dysfunction; however, there are no standards to identify and characterize the spectrum of these disorders. We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug-induced kidney disease as part of the phenotype standardization project initiated by the International Serious Adverse Events Consortium. We propose four phenotypes of drug-induced kidney disease based on clinical presentation: acute kidney injury, glomerular, tubular, and nephrolithiasis, along with the primary and secondary clinical criteria to support the phenotype definition, and a time course based on the KDIGO/AKIN definitions of acute kidney injury, acute kidney disease, and chronic kidney disease. Establishing causality in drug-induced kidney disease is challenging and requires knowledge of the biological plausibility for the specific drug, mechanism of injury, time course, and assessment of competing risk factors. These phenotypes provide a consistent framework for clinicians, investigators, industry, and regulatory agencies to evaluate drug nephrotoxicity across various settings. We believe that this is the first step to recognizing drug-induced kidney disease and developing strategies to prevent and manage this condition.
bookPart Terapias de substituição renal(2017) SILVA, Bruno Caldin da; MACEDO, EtienneconferenceObject LACTATE CLEARANCE PREDICTS MORTALITY RATE IN SEPTIC ACUTE KIDNEY INJURY PATIENTS UNDERGOING CONTINUOUS VENOVENOUS HEMODIAFILTRATION (CVVHDF): AN OBSERVATIONAL STUDY(2014) PASSOS, R.; DUTRA, F.; BATISTA, P.; MACEDO, E.; CORREIA, L.; DUTRA, M.- Clinical Approach to the Diagnosis of Acute Kidney Injury(2014) MACEDO, Etienne Maria Vasconcellos de; MEHTA, Ravindra L.