IGOR DENIZARDE BACELAR MARQUES

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  • article 38 Citação(ões) na Scopus
    Anaphylactic reaction induced by a polysulfone/polyvinylpyrrolidone membrane in the 10th session of hemodialysis with the same dialyzer
    (2011) MARQUES, Igor Denizarde Bacelar; PINHEIRO, Karina Franca; CARMO, Lilian Pires de Freitas do; COSTA, Maristela Carvalho; ABENSUR, Hugo
    The majority of severe hypersensitivity reactions in hemodialysis patients have occurred due to sensitization to ethylene oxide or to nonbiocompatible membrane dialyzers. The use of polysulfone dialyzers rarely causes hypersensitivity reactions. In the present study, we describe a case of severe life-threatening reactions induced by polysulfone dialyzers (from different manufacturers subjected to a variety of sterilization methods), which occurred after 9 sessions of hemodialysis with the same prescription, exemplifying the complexity of such reactions.
  • article 6 Citação(ões) na Scopus
    Outcomes and Mortality in Renal Transplant Recipients Admitted to the Intensive Care Unit
    (2015) MARQUES, I. D. B.; CAIRES, R. A.; MACHADO, D. J. B.; GOLDENSTEIN, P. T.; RODRIGUES, C. E.; PEGAS, J. C. R.; PAULA, F. J. de; DAVID-NETO, E.; COSTA, M. G.
    Introduction. In the intensive care unit (ICU), mortality is considered higher among renal transplant recipients than among nontransplantation patients. However, data regarding severe complications after kidney transplantation are scarce. Materials and Methods. In this study, we evaluated all consecutive renal transplant recipients admitted to our ICU between July 2012 and July 2013 (n = 70), comparing their outcomes with those of a control group of nontransplantation patients admitted during the same period (n = 153). Among the transplant recipients, we compared survivors and nonsurvivors to identify predictors of ICU mortality. Results. The mean age of the transplant recipients was 52 13 years. Of the 70 transplant recipients, 18 (25%) required mechanical ventilation, 28 (40%) required inotropic support, and 27 (39%) required hemodialysis, all of which are factors that worsen the prognosis significantly. Twenty-two (31%) of the transplant recipients died in the ICU and 17 (24%) died within 30 days after ICU discharge, rates similar to those observed for the control group. Conclusions. We observed similar mortality between recipient and control groups, albeit the mortality was higher in the clinical group. In the multivariate model, the need for mechanical ventilation and the need for hemodialysis were independently associated with mortality.
  • article 16 Citação(ões) na Scopus
    Pneumocystis jirovecii pneumonia with an atypical granulomatous response after kidney transplantation
    (2014) RAMALHO, J.; MARQUES, I. D. Bacelar; AGUIRRE, A. R.; PIERROTTI, L. C.; PAULA, F. J. de; NAHAS, W. C.; DAVID-NETO, E.
    Pneumocystis jirovecii pneumonia (PCP) continues to be a leading cause of morbidity and mortality in kidney transplant recipients. Granulomatous PCP is an unusual histological presentation that has been described in a variety of immunosuppressive conditions. Previous studies have demonstrated an association between granulomatous disorders and hypercalcemia, the purported mechanism of which is extrarenal production of 1,25-dihydroxyvitamin D by activated macrophages. Here, we report a case of granulomatous formation in a kidney transplant recipient with PCP who presented with hypercalcemia and suppressed parathyroid hormone, both of which resolved after successful treatment of the pneumonia. In immunocompromised patients, pulmonary infection associated with hypercalcemia should raise the suspicion of PCP and other granulomatous disorders.
  • bookPart
    Transplante renal
    (2017) MARQUES, Igor Denizarde Bacelar
  • conferenceObject
    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
  • article 4 Citação(ões) na Scopus
    Alteracoes vasculares em rins de doadores falecidos retardam a recuperacao da funcao do enxerto apos o transplante renal
    (2014) MARQUES, Igor Denizarde Bacelar; REPIZO, Liliany Pinhel; PONTELLI, Renato; PAULA, Flavio Jota de; NAHAS, William Carlos; DAVID, Daisa Silva Ribeiro; DAVID NETO, Elias; LEMOS, Francine Brambate Carvalhinho
    Objective: The purpose of this study was to evaluate the impact of donor and recipient characteristics on duration of delayed graft function (DGF) and 1-year serum creatinine (SCr), as a surrogate endpoint for allograft survival. Methods: We reviewed 120 first cadaver kidney transplants carried out consecutively at our center to examine the effect on 1-year SCr of the presence and duration of DGF. Results: DGF rate was 68%, with a median duration of 12 days (range, 1-61). Forty-four (38%) patients presented DGF lasting 12 or more days (prolonged DGF group). Mean donor age was 43 ± 13 years, 37% had hypertension and in 59% the cause of brain death was cardiovascular accident. The mean cold ischemia time was 23 ± 5 hours. Twenty-seven (23%) donors were classified as expanded-criteria donors according to OPTN criteria. The mean recipient age was 51 ± 15 years. The recipients median time in dialysis was 43 months (range, 1-269) and 25% of them had panel reactive antibodies > 0%. Patients with prolonged DGF presented higher 1-year SCr in comparison with patients without DGF (1.7 vs. 1.3 mg/dL, respectively, p = 0.03). In multivariate logistic regression analysis, the only significant factor contributing to the occurrence of prolonged DGF was the presence of vascular lesions in the kidney allograft at time of transplantation (HR 3.6, 95% CI 1.2-10.2; p = 0.02). Conclusion: The presence of vasculopathy in the kidney allograft at time of transplantation was identified as an important factor independently associated with prolonged DGF. Prolonged DGF negatively impacts 1-year graft function.
  • article 38 Citação(ões) na Scopus
    A Randomized Trial of Zoledronic Acid to Prevent Bone Loss in the First Year after Kidney Transplantation
    (2019) MARQUES, Igor Denizarde Bacelar; ARAUJO, Maria Julia Correia Lima Nepomuceno; GRACIOLLI, Fabiana Giorgetti; REIS, Luciene Machado dos; PEREIRA, Rosa Maria R.; ALVARENGA, Jackeline C.; CUSTODIO, Melani Ribeiro; JORGETTI, Vanda; ELIAS, Rosilene Motta; MOYSES, Rosa Maria Affonso; DAVID-NETO, Elias
    Background Bone and mineral disorders commonly affect kidney transplant (KTx) recipients and have been associated with a high risk of fracture. Bisphosphonates may prevent or treat bone loss in such patients, but there is concern that these drugs might induce adynamic bone disease (ABD). Methods In an open label, randomized trial to assess the safety and efficacy of zoledronate for preventing bone loss in the first year after kidney transplant, we randomized 34 patients before transplant to receive zoledronate or no treatment. We used dual-energy x-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and bone biopsies to evaluate changes in bone in the 32 evaluable participants between the time of KTx and 12 months post-transplant. Results Both groups of patients experienced decreased bone turnover after KTx, but zoledronate itself did not affect this outcome. Unlike previous studies, DXA showed no post-transplant bone loss in either group; we instead observed an increase of bone mineral density in both lumbar spine and total hip sites, with a significant positive effect of zoledronate. However, bone biopsies showed post-transplant impairment of trabecular connectivity (and no benefit from zoledronate); HR-pQCT detected trabecular bone loss at the peripheral skeleton, which zoledronate partially attenuated. Conclusions Current immunosuppressive regimens do not contribute to post-transplant central skeleton trabecular bone loss, and zoledronate does not induce ABD. Because fractures in transplant recipients are most commonly peripheral fractures, clinicians should consider bisphosphonate use in patients at high fracture risk who have evidence of significantly low bone mass at these sites at the time of KTx.
  • article 0 Citação(ões) na Scopus
    Biphosphonate Therapy, Risk of Fracture, and Sites of Bone Mineral Density Assessments in Kidney Transplantation Reply
    (2019) MARQUES, Igor Denizarde Bacelar; ELIAS, Rosilene Motta; MOYSES, Rosa Maria Affonso; DAVID-NETO, Elias
  • article 57 Citação(ões) na Scopus
    Peritoneal dialysis per se is a risk factor for sclerostin-associated adynamic bone disease
    (2015) OLIVEIRA, Rodrigo A. de; BARRETO, Fellype C.; MENDES, Monique; REIS, Luciene M. dos; CASTRO, Joao Henrique; BRITTO, Zita Maria L.; MARQUES, Igor D. B.; CARVALHO, Aluizio B.; MOYSES, Rosa M.; JORGETTI, Vanda
    Chronic kidney disease-mineral bone disorder (CKD-MBD) is a complex syndrome influenced by various factors, such as age, CKD etiology, uremic toxins, and dialysis modality. Although extensively studied in hemodialysis (HD) patients, only a few studies exist for peritoneal dialysis (PD) patients. Since most of these older studies contain no bone biopsy data, we studied the pattern of renal osteodystrophy in 41 prevalent PD patients. The most common presentation was adynamic bone disease (49%). There was a significant inverse association between serum sclerostin (a Wnt/beta-catenin pathway inhibitor that decreases osteoblast action and bone formation) and the bone formation rate. Bone alkaline phosphatase had the best sensitivity and specificity to detect both high-and low-turnover diseases. The comparison between nondiabetic PD and HD patients, matched by age, gender, parathyroid hormone level, and length of dialysis, revealed low 25-hydroxyvitamin D levels, worse bone mineralization, and low bone turnover in the nondiabetic PD group. Thus, adynamic bone disease was the most frequent type of renal osteodystrophy in PD patients. Sclerostin seems to participate in the pathophysiology of adynamic bone disease and bone alkaline phosphatase was the best serum marker of bone turnover in these patients.
  • conferenceObject
    LOWER SERUM MAGNESIUM 1-YEAR POSTTRANPLANTATION IS ASSOCIATED WITH PROLONGED USE OF PROTON PUMP INHIBITORS AND DECREASED GRAFT SURVIVAL IN RENAL TRANSPLANT RECIPIENTS
    (2013) NIHEI, Camila; MARQUES, Igor Bacelar; SEGURO, Carlos Antonio; DAVID-NETO, Elias
    Introduction and Aims: Hypomagnesaemia is a known side effect of immunosuppressive regimen, especially calcineurin inhibitors, and has been associated with new onset diabetes after transplantation (NODAT), decreased graft survival in chronic cyclosporine nephrotoxicity and vascular stiffness. Proton pump inhibitors-induced hypomagnesaemia has been described recently, although its relevance in renal transplant recipients is still unknown. Methods: We conducted a single center cross-sectional retrospective study of renal transplantations performed between 2006 and 2011 in order to evaluate the impact of low serum magnesium (Mg) levels in patient and graft outcomes. Serum Mg levels 1-year after renal transplantation were available for 316 patients. Results: The median follow-up was 1062 days (range, 284–2287). Patients were divided into four groups, based in quartiles of serum Mg levels, and no significant differences were found regarding sex, age, pretransplantation cholesterol, albumin, triglycerides, body mass index, donor age and type, immunosuppressive regimen, use of Mg supplements, delayed graft function, acute rejection, CMV and HCV infection, or NODAT development. Patients with Mg < 1.6 mg/dL (n=80) had a higher frequency of prolonged (> 1 year) proton pump inhibitors use (90% vs. 81%, p=0.04), when compared to patients with Mg > 2 mg/dL (n=81). Using Cox multivariate regression analyses, adjusted for recipient age, donor age and type, immunosuppressive regimen, diabetes, NODAT and presence of acute rejection, graft survival was significantly reduced in the low Mg group after 4.6 years posttransplantion (p=0.001). Conclusions: Hypomagnesaemia 1-year posttransplantation, possibly related to prolonged use (> 1 year) of proton pump inhibitors, is associated with decreased graft survival in renal transplant recipients.