Suzimar Rioja | UERJ - Universidade do Estado do Rio de Janeiro / Rio de Janeiro State University (original) (raw)

Papers by Suzimar Rioja

Research paper thumbnail of Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?

Nutrition, 2013

The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk f... more The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women. In this retrospective cross-sectional study, 102 patients (55 men) who were 49 ± 1.2 y and 114.3 ± 9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and weight gain during the first year post-tx were obtained from patient charts and post-tx data were collected during a routine visit at nephrology clinic. Body mass index (BMI) ≥ 25 kg/m(2) defined overweight and BMI ≥ 30 kg/m(2) defined obesity. Pre-tx overweight prevalence was low and similar between men and women (26%), whereas only women showed obesity (11%). Post-tx body weight increased significantly in the entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity (to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women showed that women had higher (women versus men; P < 0.05) BMI values (26.7 ± 0.8 versus 24.7 ± 0.5 kg/m(2)), weight gain during first year post-tx (9.2 ± 1.1 versus 5.5 ± 1 kg), abdominal obesity (57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx; pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal obesity increased the risk for dyslipidemia in women. High body adiposity prevalence was high after transplantation and increased the risk for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the risk for dyslipidemia in women.

Research paper thumbnail of Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients

Medicine

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to... more Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears. Abbreviations: FH = functional hyposplenism, HJ+ = HJB present, HJ-= HJB absent, HJBs = Howell-Jolly bodies, RES = reticuloendothelial system, RI = resistive indice, SD = standard deviations, SPSS = Statistical Package for the Social Sciences.

Research paper thumbnail of Vitamin B12 status in kidney transplant recipients: association with dietary intake, body adiposity and immunosuppression

British Journal of Nutrition

The aim of the present study was to evaluate the prevalence of vitamin B12 (B12) deficiency in ki... more The aim of the present study was to evaluate the prevalence of vitamin B12 (B12) deficiency in kidney transplant recipients (KTR), and its possible association with B12 dietary intake, body adiposity, and immunosuppressive drugs. In this cross-sectional study were included 225 KTR, aged 47.50±12.11years, and 125 (56%) were men. Serum levels of B12 were determined by chemiluminescent microparticle intrinsic factor assay and the cut-off of 200 pg/mL was used to stratify KTR into B12 sufficient or B12 deficient group. B12 dietary intake was evaluated by three 24h dietary recalls and was considered adequate when ≥ 2.4 mcg/day. Body adiposity was estimated after taking anthropometric measures and using dual energy x-ray absorptiometry (DXA) method. B12 deficiency was seen in 14% of the individuals. B12 deficient group, compared to the B12 sufficient group, exhibited lower intake of B12 [2.42(1.41-3.23) vs. 3.16(1.94-4.55) mcg/day, p=0.04] and higher values of waist circumference [96.0(88...

Research paper thumbnail of {"__content__"=>"Endocarditis due to in a kidney transplanted patient: case report and review of medical literature.", "i"=>{"__content__"=>"Rhodotorula mucilaginosa"}}

JMM case reports, 2017

Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when ... more Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when accompanied byfever of unknown origin, is more severe since interferes with proper diagnosis and endocarditis treatment. The Rio de Janeiro Infective Endocarditis Study Group reports a case of infectious endocarditis (IE) with negative blood cultures in a 45-year-old white female resident in Rio de Janeiro, Brazil, previously submitted to kidney transplantation. After diagnosis and intervention, the valve culture revealed . The clinical aspects and overview of endocarditis caused by spp. demonstrated that have been isolated from the last IE cases from kidney transplanted patients. Though most of the patients (in literature) recovered well from endocarditis caused by spp., physicians must be aware for diagnosis of fungemia and fungal treatment in kidney transplanted patients suffering of fever of unknown origin in the modern immunosuppressive treatment.

Research paper thumbnail of Avaliaçäo eletroneuromiográfica na neuropatia urêmica

Research paper thumbnail of Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?

a b s t r a c t Objective: The aim of this study was to evaluate high body adiposity and cardiova... more a b s t r a c t
Objective: The aim of this study was to evaluate high body adiposity and cardiovascular disease
(CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women.
Methods: In this retrospective cross-sectional study, 102 patients (55 men) who were 49  1.2 y
and 114.3  9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and
weight gain during the first year post-tx were obtained from patient charts and post-tx data were
collected during a routine visit at nephrology clinic. Body mass index (BMI)  25 kg/m2 defined
overweight and BMI  30 kg/m2 defined obesity.
Results: Pre-tx overweight prevalence was low and similar between men and women (26%),
whereas only women showed obesity (11%). Post-tx body weight increased significantly in the
entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity
(to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women
showed that women had higher (women versus men; P < 0.05) BMI values (26.7  0.8 versus 24.7
 0.5 kg/m2), weight gain during first year post-tx (9.2  1.1 versus 5.5  1 kg), abdominal obesity
(57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity
and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx;
pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal
obesity increased the risk for dyslipidemia in women.
Conclusions: High body adiposity prevalence was high after transplantation and increased the risk
for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity
values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the
risk for dyslipidemia in women.

Research paper thumbnail of Is hepatitis C a risk factor to posttransplant diabetes mellitus after renal transplantation in patients using tacrolimus?

Abstract The objective of this study was to evaluate the association between previous hepatiti... more Abstract

The objective of this study was to evaluate the association between previous hepatitis C virus (HCV) infection and the occurrence of posttransplant diabetes mellitus (PTDM) among patients undergoing kidney transplants using tacrolimus (FK). From August 1999 to January 2003, 66 patients (36.4 ± 15.5 years) underwent kidney transplantation using an immunosuppressive regimen of tacrolimus, mycophenolate mofetil, or azathioprine and steroids. Thirty-four patients (52%) received kidneys from living donors and 32 (48%) from cadaveric donors. The diagnosis of diabetes mellitus was established after two consecutive ambulatory measurements of fasting glycemia ≥ 126 mg/dL. Thirty-five percent of the patients (23/66) were HCV+ and 65% (43/66) HCV−. Of the 66 patients, 33% (22) developed PTDM, 19 (82%) from the HCV+ group and only 3 (7%) from the HCV− group. Among those who developed PDTM, the diagnosis was established in the first 2 posttransplant months in most cases (68.2%). The results showed a significant association between HCV and PTDM (P ≤ 0.0001). In this group of patients HCV infection was strongly associated with the development of PTDM. Therefore, additional care is required regarding the immunosuppressive regimen among patients with chronic HCV infection.

Posttransplant diabetes mellitus (PTDM), a frequent complication of some immunosuppressants, has been observed in 5% to 30% of the kidney transplant recipients.1 Several risk factors correlate with onset, such as age, race, family history, and drugs, including tacrolimus (FK). FK-induced diabetes mellitus is generally associated with the concomitant use of steroids, with FK blood level and, with recipient race. Recent studies suggest an association between PTDM and infection with hepatitis C virus (HCV) among kidney transplant patients.2 This work evaluated the incidence of PTDM among patients receiving FK to analyze HCV infection as a possible risk factor.

Research paper thumbnail of Prospective Observational Study of Sirolimus as

Background. Sirolimus (SRL) is an important component of clinical immunosuppression in renal tran... more Background. Sirolimus (SRL) is an important component of clinical immunosuppression in renal transplantation, but
few international studies have examined how this agent is used in routine practice.
Methods. Within a large prospective pharmacoepidemiological study, 718 de novo renal graft recipients treated with
SRL in 65 centers in 10 countries were monitored for up to 5 years posttransplant to compare the principal outcomes
and adverse effects by treatment regimen.
Results. Principal treatment regimens were SRL without a calcineurin inhibitor (33%), SRLcyclosporine A (CsA)
(33%), and SRLtacrolimus (TAC) (34%); 18% of subjects discontinued SRL, 124/718 (17%) developed biopsyconfirmed
acute rejection (BCAR), 64/718 (9%) lost their graft, and 50/718 (7%) died during follow-up. Calculated
creatinine clearance was 6626 mL/min at 2 years. The most common adverse events were hypertension, hyperlipidemia,
anemia, urinary tract infections, and diabetes. BCAR was significantly lower in subjects receiving SRLTAC
(hazard ratio [HR] 0.46, P0.009) but not significantly lower in those receiving SRLCsA (HR 0.62, P0.102)
compared with SRL without a calcineurin inhibitor. Graft loss or death did not significantly differ between treatment
groups but were associated, respectively, with deceased donor grafts (HR 3.33, P0.001) and increased age (HR 1.04,
P0.001). No improvement was observed in patients receiving mycophenolate mofetil in any treatment combination
(HR 0.80, P0.438 for BCAR; HR 0.93, P0.849 for graft loss; and HR 0.75, P0.531 for death).
Conclusions. SRL is most commonly used in combination with mycophenolate mofetil, CsA, or TAC. BCAR was least
common in subjects receiving SRLTAC, but other outcomes seemed comparable between the treatment regimens in
routine practice.
Keywords: Transplantation, Kidney, Sirolimus, Immunosuppression, Rejection.
(Transplantation 2009;88: 1010–1018)

Research paper thumbnail of Effect of rapamycin on spleen size in long-standing renal transplant recipients

Based on evidence available in the literature, rapamycin, a mammalian target of rapamycin (mTOR)... more Based on evidence available in the literature, rapamycin, a mammalian
target of rapamycin (mTOR) inhibitor, but not calcineurin inhibitors (CNIs), has been
shown to decrease spleen size. Small spleen, in some instances, is associated with hyposplenism,
a condition recently reported in patients with longstanding renal transplant.
Accordingly, the effect of immunosuppressive drugs on spleen size was evaluated.
Methods. Renal transplant recipients (35 taking mTOR and 68 CNI) were included, in
whom a standardized investigation of the kidney allograft and spleen with the use of color
Doppler ultrasound was performed and a peripheral smear were reviewed for the presence
of Howell-Jolly bodies (HJBs).
Results. We enrolled 103 patients (64 men; 66 from a deceased donor). The mean age
was 47.7 years (range, 23.0e74.0 y). Mean transplant duration was 1,899 days (range,
181e6,883 d). According to the presence of HJBs, the prevalence of hyposplenism was
47.6% for the entire cohort. The differences between the mTOR and CNI groups regarding
sex and the presence of HJBs were not statistically significant (P > .05). Age, creatinine,
hemoglobin, leukocytes, platelets, and Doppler parameters in spleen and kidney were
similar in both groups (P > .05). mTOR patients had a decreased spleen length size (90.09
 13.02 mm vs 111.95  18.66 mm; P < .001), a longer transplant duration (3,576  1,594
d vs 1,036  1,369 d; P < .001) and higher serum cholesterol (227.50  38.75 mg/dL vs
182.67  37.74 mg/dL; P < .001) and triglycerides (194.23  79.88 mg/dL vs 148.70  55.54
mg/dL; P ¼ .003) levels compared with the CNI group. A multivariate analysis showed
mTOR inhibitor to be the most important predictor of spleen size. In both the mTOR and
CNI groups, the comparison between the subgroups of present and absent HJBs did not
show any difference.
Conclusions. The findings of this study suggest that small spleens in transplant recipients
may be linked to treatment with an mTOR inhibitor, although this apparently does not
compromise splenic function.

Research paper thumbnail of Functional hyposplenism in renal transplant

A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal gr... more A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. Methods. We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ ϩ ) or absent (HJ Ϫ ) groups for further comparison. Results. The overall mean age of 21 females and 26 males was 47.8 Ϯ 12.0 years, and the mean time after transplantation was 2750 Ϯ 1818 days (range, 208 -6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ ϩ group (P Ͻ .05). There was no difference in spleen size between the groups. Discussion. HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.

Research paper thumbnail of Trimethoprim-sulfamethoxazole and fluoroquinolones resistant Escherichia coli in communityacquired and nosocomial urinary tract infections in Rio de Janeiro, Brazil

Abstract: To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of... more Abstract: To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of
urinary tract infections (UTI) in patients attending a tertiary university hospital of Rio de Janeiro,
Brazil. Antibiotic susceptibility testing was performed by the disk diffusion method. MDR, extensivelyresistance
(XDR) and pan-resistance (PDR) were defined by using recently described criteria.
Retrospective analyses of clinical, microbiological and demographic features of outpatients and
inpatients with UTI (n=416) were also performed. High antibiotic resistance rates for trimethoprimsulfamethoxazole
- SXT-TMP (n=177; 46.7%) and fluoroquinolones - FQ [n=117; norfloxacin (27%)
and ciprofloxacin (26.8%) - (FQ) were demonstrated for E. coli strains isolated from community and
healthcare-onsets. Risk factors associated with UTIs due to MDR E. coli isolates included prior threemonth
hospitalization (OR: 2.4; CI 95%: 1.3-4.4; p<0.005), presence of neurogenic bladder (OR: 3.7; CI
95% :1.7-8.3; p<0.01 ) and kidney transplantation (OR: 3.1; CI 95%:1-0.5; p<0.04). A high prevalence
of community-acquired and nosocomial urinary tract infections due SXT-TMP/FQ resistant E. coli
strains was observed in Rio de Janeiro metropolitan area, Brazil. According to IDSA Guidelines, initial
empirical therapy for community-associated UTI with SXT-TMP and FQ should be avoided in Rio de
Janeiro. Nitrofurantoin, amoxicillin/clavulanic, piperacillin/tazobactam or gentamicin associations
were effective for the empiric therapy for community-acquired and healthcare-associated UTIs,
respectively.

Research paper thumbnail of The first case report of non-nosocomial healthcare-associated infective endocarditis due to methicillin-resistant Staphylococcus aureus USA400 in Rio de Janeiro, Brazil

Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have ... more Staphylococcus aureus is the main causal
pathogen of infective endocarditis (IE), which may have
distinct origins, namely, community, nosocomial, or nonnosocomial
healthcare-associated (NNHCA). We report
the first case of NNHCA-IE caused by methicillin-resistant
S. aureus strain USA400/SCCmec IV in which the combination
therapy of rifampin and vancomycin had a
favorable outcome for the patient.

Research paper thumbnail of Infectious disease

Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have ... more Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have distinct origins, namely, community, nosocomial, or nonnosocomial healthcare-associated (NNHCA). We report the first case of NNHCA-IE caused by methicillin-resistant S. aureus strain USA400/SCCmec IV in which the combination therapy of rifampin and vancomycin had a favorable outcome for the patient.

Research paper thumbnail of Infectious disease

To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of urinary t... more To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of urinary tract infections (UTI) in patients attending a tertiary university hospital of Rio de Janeiro, Brazil. Antibiotic susceptibility testing was performed by the disk diffusion method. MDR, extensivelyresistance (XDR) and pan-resistance (PDR) were defined by using recently described criteria. Retrospective analyses of clinical, microbiological and demographic features of outpatients and inpatients with UTI (n=416) were also performed. High antibiotic resistance rates for trimethoprimsulfamethoxazole -SXT-TMP (n=177; 46.7%) and fluoroquinolones -FQ [n=117; norfloxacin (27%) and ciprofloxacin (26.8%) -(FQ) were demonstrated for E. coli strains isolated from community and healthcare-onsets. Risk factors associated with UTIs due to MDR E. coli isolates included prior threemonth hospitalization (OR: 2.4; CI 95%: 1.3-4.4; p<0.005), presence of neurogenic bladder (OR: 3.7; CI 95% :1.7-8.3; p<0.01 ) and kidney transplantation (OR: 3.1; CI 95%:1-0.5; p<0.04). A high prevalence of community-acquired and nosocomial urinary tract infections due SXT-TMP/FQ resistant E. coli strains was observed in Rio de Janeiro metropolitan area, Brazil. According to IDSA Guidelines, initial empirical therapy for community-associated UTI with SXT-TMP and FQ should be avoided in Rio de Janeiro. Nitrofurantoin, amoxicillin/clavulanic, piperacillin/tazobactam or gentamicin associations were effective for the empiric therapy for community-acquired and healthcare-associated UTIs, respectively.

Research paper thumbnail of Renal transplant and infectous disease

A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal gr... more A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. Methods. We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ ϩ ) or absent (HJ Ϫ ) groups for further comparison. Results. The overall mean age of 21 females and 26 males was 47.8 Ϯ 12.0 years, and the mean time after transplantation was 2750 Ϯ 1818 days (range, 208 -6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ ϩ group (P Ͻ .05). There was no difference in spleen size between the groups. Discussion. HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.

Research paper thumbnail of Panel reactive HLA antibodies, soluble CD30 levels, and acute rejection six months following renal transplant

Clinical Transplantation, 2009

Specific anti-human leukocyte antigen antibodies (HLA) in the post-transplant period may be prese... more Specific anti-human leukocyte antigen antibodies (HLA) in the post-transplant period may be present with acute rejection episodes (ARE), and high soluble CD30 (sCD30) serum levels may be a risk factor for ARE and graft loss. HLA cross-matching, panel reactive antibodies (PRA), and sCD30 levels were determined prior to transplantation in 72 patients. Soluble CD30 levels and PRA were re-assessed at day 7, 14, 21, and 28, and monthly up to the sixth. Twenty-four subjects had a positive PRA and 17 experienced ARE. Nine of 17 ARE subjects demonstrated positive PRA and 16 had HLA mismatches. Positive PRA was more frequent in ARE subjects (p = 0.03). Eight subjects with ARE had donor-specific antibodies (DSA) in serum samples pre-transplantation, two subjects developed DSA. Three subjects without ARE had positive PRA only in post-transplantation samples. Soluble CD30 levels were higher in pre-transplant samples and ARE subjects than non-ARE subjects (p = 0.03). Post-transplant sCD30 levels were elevated in subjects who experienced rejection and were significantly higher at seven d (p = 0.0004) and six months (p = 0.03). Higher sCD30 levels following transplant were associated with ARE. Elevated sCD30 levels may represent a risk factor for acute rejection.

Research paper thumbnail of Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?

Nutrition, 2013

The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk f... more The aim of this study was to evaluate high body adiposity and cardiovascular disease (CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women. In this retrospective cross-sectional study, 102 patients (55 men) who were 49 ± 1.2 y and 114.3 ± 9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and weight gain during the first year post-tx were obtained from patient charts and post-tx data were collected during a routine visit at nephrology clinic. Body mass index (BMI) ≥ 25 kg/m(2) defined overweight and BMI ≥ 30 kg/m(2) defined obesity. Pre-tx overweight prevalence was low and similar between men and women (26%), whereas only women showed obesity (11%). Post-tx body weight increased significantly in the entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity (to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women showed that women had higher (women versus men; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) BMI values (26.7 ± 0.8 versus 24.7 ± 0.5 kg/m(2)), weight gain during first year post-tx (9.2 ± 1.1 versus 5.5 ± 1 kg), abdominal obesity (57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx; pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal obesity increased the risk for dyslipidemia in women. High body adiposity prevalence was high after transplantation and increased the risk for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the risk for dyslipidemia in women.

Research paper thumbnail of Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients

Medicine

Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to... more Given discrepancies between methods for diagnosing hyposplenism, the purpose of this study was to evaluate the effect of the spleen size on the correlation between the methods, and to propose a model for improving the interpretation. Patients with renal allografts were included, in whom the spleen was assessed using Doppler ultrasound, scintiscan, and the presence of Howell-Jolly bodies (HJBs) in peripheral smears. In 35 subjects, scintiscan and HJBs were normal (Group 0); 20 had an abnormal result in both methods (Group 1); 34 had discordant results with HJBs present (Group 2); and 14 had discordant results with decreased spleen uptake (Group 3). There was no association between HJBs and scintiscan. The patients of Groups 1 and 2 had smaller spleens. The patients with smaller spleen had more hematological evidence of hyposplenism and exhibit smaller discrepancies between the methods than patients with larger spleen. The spleen can tip the balance from a normal to impaired function provided that the spleen size is below the critical mass required to maintain splenic function. A mild impairment of phagocytic function and slight dyserythropoiesis along with a small spleen would result in decreased take up of radiocolloid or the appearance of HJBs in blood smears. Abbreviations: FH = functional hyposplenism, HJ+ = HJB present, HJ-= HJB absent, HJBs = Howell-Jolly bodies, RES = reticuloendothelial system, RI = resistive indice, SD = standard deviations, SPSS = Statistical Package for the Social Sciences.

Research paper thumbnail of Vitamin B12 status in kidney transplant recipients: association with dietary intake, body adiposity and immunosuppression

British Journal of Nutrition

The aim of the present study was to evaluate the prevalence of vitamin B12 (B12) deficiency in ki... more The aim of the present study was to evaluate the prevalence of vitamin B12 (B12) deficiency in kidney transplant recipients (KTR), and its possible association with B12 dietary intake, body adiposity, and immunosuppressive drugs. In this cross-sectional study were included 225 KTR, aged 47.50±12.11years, and 125 (56%) were men. Serum levels of B12 were determined by chemiluminescent microparticle intrinsic factor assay and the cut-off of 200 pg/mL was used to stratify KTR into B12 sufficient or B12 deficient group. B12 dietary intake was evaluated by three 24h dietary recalls and was considered adequate when ≥ 2.4 mcg/day. Body adiposity was estimated after taking anthropometric measures and using dual energy x-ray absorptiometry (DXA) method. B12 deficiency was seen in 14% of the individuals. B12 deficient group, compared to the B12 sufficient group, exhibited lower intake of B12 [2.42(1.41-3.23) vs. 3.16(1.94-4.55) mcg/day, p=0.04] and higher values of waist circumference [96.0(88...

Research paper thumbnail of {"__content__"=>"Endocarditis due to in a kidney transplanted patient: case report and review of medical literature.", "i"=>{"__content__"=>"Rhodotorula mucilaginosa"}}

JMM case reports, 2017

Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when ... more Endocarditis caused by yeasts is currently an emerging cause of infective endocarditis and, when accompanied byfever of unknown origin, is more severe since interferes with proper diagnosis and endocarditis treatment. The Rio de Janeiro Infective Endocarditis Study Group reports a case of infectious endocarditis (IE) with negative blood cultures in a 45-year-old white female resident in Rio de Janeiro, Brazil, previously submitted to kidney transplantation. After diagnosis and intervention, the valve culture revealed . The clinical aspects and overview of endocarditis caused by spp. demonstrated that have been isolated from the last IE cases from kidney transplanted patients. Though most of the patients (in literature) recovered well from endocarditis caused by spp., physicians must be aware for diagnosis of fungemia and fungal treatment in kidney transplanted patients suffering of fever of unknown origin in the modern immunosuppressive treatment.

Research paper thumbnail of Avaliaçäo eletroneuromiográfica na neuropatia urêmica

Research paper thumbnail of Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences between sexes?

a b s t r a c t Objective: The aim of this study was to evaluate high body adiposity and cardiova... more a b s t r a c t
Objective: The aim of this study was to evaluate high body adiposity and cardiovascular disease
(CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women.
Methods: In this retrospective cross-sectional study, 102 patients (55 men) who were 49  1.2 y
and 114.3  9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and
weight gain during the first year post-tx were obtained from patient charts and post-tx data were
collected during a routine visit at nephrology clinic. Body mass index (BMI)  25 kg/m2 defined
overweight and BMI  30 kg/m2 defined obesity.
Results: Pre-tx overweight prevalence was low and similar between men and women (26%),
whereas only women showed obesity (11%). Post-tx body weight increased significantly in the
entire group, leading to an increase in overweight (to 38% in men and 51% in women) and obesity
(to 11% in men and 23% in women) prevalence. Post-tx comparisons between men and women
showed that women had higher (women versus men; P < 0.05) BMI values (26.7  0.8 versus 24.7
 0.5 kg/m2), weight gain during first year post-tx (9.2  1.1 versus 5.5  1 kg), abdominal obesity
(57% versus 23%) and diabetes (34% versus 16%) prevalence. The associations between adiposity
and CVD risk factors showed that pre-tx overweight increased the risk for diabetes in post-tx;
pos-tx high BMI and abdominal obesity increased the risk for metabolic syndrome; abdominal
obesity increased the risk for dyslipidemia in women.
Conclusions: High body adiposity prevalence was high after transplantation and increased the risk
for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity
values, abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the
risk for dyslipidemia in women.

Research paper thumbnail of Is hepatitis C a risk factor to posttransplant diabetes mellitus after renal transplantation in patients using tacrolimus?

Abstract The objective of this study was to evaluate the association between previous hepatiti... more Abstract

The objective of this study was to evaluate the association between previous hepatitis C virus (HCV) infection and the occurrence of posttransplant diabetes mellitus (PTDM) among patients undergoing kidney transplants using tacrolimus (FK). From August 1999 to January 2003, 66 patients (36.4 ± 15.5 years) underwent kidney transplantation using an immunosuppressive regimen of tacrolimus, mycophenolate mofetil, or azathioprine and steroids. Thirty-four patients (52%) received kidneys from living donors and 32 (48%) from cadaveric donors. The diagnosis of diabetes mellitus was established after two consecutive ambulatory measurements of fasting glycemia ≥ 126 mg/dL. Thirty-five percent of the patients (23/66) were HCV+ and 65% (43/66) HCV−. Of the 66 patients, 33% (22) developed PTDM, 19 (82%) from the HCV+ group and only 3 (7%) from the HCV− group. Among those who developed PDTM, the diagnosis was established in the first 2 posttransplant months in most cases (68.2%). The results showed a significant association between HCV and PTDM (P ≤ 0.0001). In this group of patients HCV infection was strongly associated with the development of PTDM. Therefore, additional care is required regarding the immunosuppressive regimen among patients with chronic HCV infection.

Posttransplant diabetes mellitus (PTDM), a frequent complication of some immunosuppressants, has been observed in 5% to 30% of the kidney transplant recipients.1 Several risk factors correlate with onset, such as age, race, family history, and drugs, including tacrolimus (FK). FK-induced diabetes mellitus is generally associated with the concomitant use of steroids, with FK blood level and, with recipient race. Recent studies suggest an association between PTDM and infection with hepatitis C virus (HCV) among kidney transplant patients.2 This work evaluated the incidence of PTDM among patients receiving FK to analyze HCV infection as a possible risk factor.

Research paper thumbnail of Prospective Observational Study of Sirolimus as

Background. Sirolimus (SRL) is an important component of clinical immunosuppression in renal tran... more Background. Sirolimus (SRL) is an important component of clinical immunosuppression in renal transplantation, but
few international studies have examined how this agent is used in routine practice.
Methods. Within a large prospective pharmacoepidemiological study, 718 de novo renal graft recipients treated with
SRL in 65 centers in 10 countries were monitored for up to 5 years posttransplant to compare the principal outcomes
and adverse effects by treatment regimen.
Results. Principal treatment regimens were SRL without a calcineurin inhibitor (33%), SRLcyclosporine A (CsA)
(33%), and SRLtacrolimus (TAC) (34%); 18% of subjects discontinued SRL, 124/718 (17%) developed biopsyconfirmed
acute rejection (BCAR), 64/718 (9%) lost their graft, and 50/718 (7%) died during follow-up. Calculated
creatinine clearance was 6626 mL/min at 2 years. The most common adverse events were hypertension, hyperlipidemia,
anemia, urinary tract infections, and diabetes. BCAR was significantly lower in subjects receiving SRLTAC
(hazard ratio [HR] 0.46, P0.009) but not significantly lower in those receiving SRLCsA (HR 0.62, P0.102)
compared with SRL without a calcineurin inhibitor. Graft loss or death did not significantly differ between treatment
groups but were associated, respectively, with deceased donor grafts (HR 3.33, P0.001) and increased age (HR 1.04,
P0.001). No improvement was observed in patients receiving mycophenolate mofetil in any treatment combination
(HR 0.80, P0.438 for BCAR; HR 0.93, P0.849 for graft loss; and HR 0.75, P0.531 for death).
Conclusions. SRL is most commonly used in combination with mycophenolate mofetil, CsA, or TAC. BCAR was least
common in subjects receiving SRLTAC, but other outcomes seemed comparable between the treatment regimens in
routine practice.
Keywords: Transplantation, Kidney, Sirolimus, Immunosuppression, Rejection.
(Transplantation 2009;88: 1010–1018)

Research paper thumbnail of Effect of rapamycin on spleen size in long-standing renal transplant recipients

Based on evidence available in the literature, rapamycin, a mammalian target of rapamycin (mTOR)... more Based on evidence available in the literature, rapamycin, a mammalian
target of rapamycin (mTOR) inhibitor, but not calcineurin inhibitors (CNIs), has been
shown to decrease spleen size. Small spleen, in some instances, is associated with hyposplenism,
a condition recently reported in patients with longstanding renal transplant.
Accordingly, the effect of immunosuppressive drugs on spleen size was evaluated.
Methods. Renal transplant recipients (35 taking mTOR and 68 CNI) were included, in
whom a standardized investigation of the kidney allograft and spleen with the use of color
Doppler ultrasound was performed and a peripheral smear were reviewed for the presence
of Howell-Jolly bodies (HJBs).
Results. We enrolled 103 patients (64 men; 66 from a deceased donor). The mean age
was 47.7 years (range, 23.0e74.0 y). Mean transplant duration was 1,899 days (range,
181e6,883 d). According to the presence of HJBs, the prevalence of hyposplenism was
47.6% for the entire cohort. The differences between the mTOR and CNI groups regarding
sex and the presence of HJBs were not statistically significant (P > .05). Age, creatinine,
hemoglobin, leukocytes, platelets, and Doppler parameters in spleen and kidney were
similar in both groups (P > .05). mTOR patients had a decreased spleen length size (90.09
 13.02 mm vs 111.95  18.66 mm; P < .001), a longer transplant duration (3,576  1,594
d vs 1,036  1,369 d; P < .001) and higher serum cholesterol (227.50  38.75 mg/dL vs
182.67  37.74 mg/dL; P < .001) and triglycerides (194.23  79.88 mg/dL vs 148.70  55.54
mg/dL; P ¼ .003) levels compared with the CNI group. A multivariate analysis showed
mTOR inhibitor to be the most important predictor of spleen size. In both the mTOR and
CNI groups, the comparison between the subgroups of present and absent HJBs did not
show any difference.
Conclusions. The findings of this study suggest that small spleens in transplant recipients
may be linked to treatment with an mTOR inhibitor, although this apparently does not
compromise splenic function.

Research paper thumbnail of Functional hyposplenism in renal transplant

A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal gr... more A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. Methods. We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ ϩ ) or absent (HJ Ϫ ) groups for further comparison. Results. The overall mean age of 21 females and 26 males was 47.8 Ϯ 12.0 years, and the mean time after transplantation was 2750 Ϯ 1818 days (range, 208 -6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ ϩ group (P Ͻ .05). There was no difference in spleen size between the groups. Discussion. HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.

Research paper thumbnail of Trimethoprim-sulfamethoxazole and fluoroquinolones resistant Escherichia coli in communityacquired and nosocomial urinary tract infections in Rio de Janeiro, Brazil

Abstract: To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of... more Abstract: To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of
urinary tract infections (UTI) in patients attending a tertiary university hospital of Rio de Janeiro,
Brazil. Antibiotic susceptibility testing was performed by the disk diffusion method. MDR, extensivelyresistance
(XDR) and pan-resistance (PDR) were defined by using recently described criteria.
Retrospective analyses of clinical, microbiological and demographic features of outpatients and
inpatients with UTI (n=416) were also performed. High antibiotic resistance rates for trimethoprimsulfamethoxazole
- SXT-TMP (n=177; 46.7%) and fluoroquinolones - FQ [n=117; norfloxacin (27%)
and ciprofloxacin (26.8%) - (FQ) were demonstrated for E. coli strains isolated from community and
healthcare-onsets. Risk factors associated with UTIs due to MDR E. coli isolates included prior threemonth
hospitalization (OR: 2.4; CI 95%: 1.3-4.4; p<0.005), presence of neurogenic bladder (OR: 3.7; CI
95% :1.7-8.3; p<0.01 ) and kidney transplantation (OR: 3.1; CI 95%:1-0.5; p<0.04). A high prevalence
of community-acquired and nosocomial urinary tract infections due SXT-TMP/FQ resistant E. coli
strains was observed in Rio de Janeiro metropolitan area, Brazil. According to IDSA Guidelines, initial
empirical therapy for community-associated UTI with SXT-TMP and FQ should be avoided in Rio de
Janeiro. Nitrofurantoin, amoxicillin/clavulanic, piperacillin/tazobactam or gentamicin associations
were effective for the empiric therapy for community-acquired and healthcare-associated UTIs,
respectively.

Research paper thumbnail of The first case report of non-nosocomial healthcare-associated infective endocarditis due to methicillin-resistant Staphylococcus aureus USA400 in Rio de Janeiro, Brazil

Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have ... more Staphylococcus aureus is the main causal
pathogen of infective endocarditis (IE), which may have
distinct origins, namely, community, nosocomial, or nonnosocomial
healthcare-associated (NNHCA). We report
the first case of NNHCA-IE caused by methicillin-resistant
S. aureus strain USA400/SCCmec IV in which the combination
therapy of rifampin and vancomycin had a
favorable outcome for the patient.

Research paper thumbnail of Infectious disease

Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have ... more Staphylococcus aureus is the main causal pathogen of infective endocarditis (IE), which may have distinct origins, namely, community, nosocomial, or nonnosocomial healthcare-associated (NNHCA). We report the first case of NNHCA-IE caused by methicillin-resistant S. aureus strain USA400/SCCmec IV in which the combination therapy of rifampin and vancomycin had a favorable outcome for the patient.

Research paper thumbnail of Infectious disease

To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of urinary t... more To investigate the multidrug resistance (MDR) patterns of Escherichia coli causative of urinary tract infections (UTI) in patients attending a tertiary university hospital of Rio de Janeiro, Brazil. Antibiotic susceptibility testing was performed by the disk diffusion method. MDR, extensivelyresistance (XDR) and pan-resistance (PDR) were defined by using recently described criteria. Retrospective analyses of clinical, microbiological and demographic features of outpatients and inpatients with UTI (n=416) were also performed. High antibiotic resistance rates for trimethoprimsulfamethoxazole -SXT-TMP (n=177; 46.7%) and fluoroquinolones -FQ [n=117; norfloxacin (27%) and ciprofloxacin (26.8%) -(FQ) were demonstrated for E. coli strains isolated from community and healthcare-onsets. Risk factors associated with UTIs due to MDR E. coli isolates included prior threemonth hospitalization (OR: 2.4; CI 95%: 1.3-4.4; p<0.005), presence of neurogenic bladder (OR: 3.7; CI 95% :1.7-8.3; p<0.01 ) and kidney transplantation (OR: 3.1; CI 95%:1-0.5; p<0.04). A high prevalence of community-acquired and nosocomial urinary tract infections due SXT-TMP/FQ resistant E. coli strains was observed in Rio de Janeiro metropolitan area, Brazil. According to IDSA Guidelines, initial empirical therapy for community-associated UTI with SXT-TMP and FQ should be avoided in Rio de Janeiro. Nitrofurantoin, amoxicillin/clavulanic, piperacillin/tazobactam or gentamicin associations were effective for the empiric therapy for community-acquired and healthcare-associated UTIs, respectively.

Research paper thumbnail of Renal transplant and infectous disease

A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal gr... more A nephrologist with expertise in ultrasonography noticed that patients with longstanding renal grafts had smaller spleens than subjects undergoing initial post-transplantation imaging. This putative finding prompted us to pursue a further investigation into splenic function based on Doppler ultrasound and hematologic parameters. Methods. We enrolled 47 patients with functioning long-standing kidney grafts, measuring longitudinal diameter of the spleen, hilar and intrasplenic peak systolic velocities (PSV), and hilar and intrasplenic resistivity indices of the splenic artery as well as mean arterial blood pressure (MAP). Giemsa-stained peripheral blood smears were examined for the presence of Howell-Jolly bodies (HJBs) using light microscopy. The patients were then divided into HJB present (HJ ϩ ) or absent (HJ Ϫ ) groups for further comparison. Results. The overall mean age of 21 females and 26 males was 47.8 Ϯ 12.0 years, and the mean time after transplantation was 2750 Ϯ 1818 days (range, 208 -6446). HJBs were detected in 23/47 patients (48.9%). The intrasplenic artery PSV was significantly lower and MAP higher in the HJ ϩ group (P Ͻ .05). There was no difference in spleen size between the groups. Discussion. HJBs in peripheral blood red cells, an indicator of hyposplenism, was associated with reduced intrasplenic artery PSV, suggesting dysfunction, which may play a role in the known vulnerability of renal transplant recipients to infections.

Research paper thumbnail of Panel reactive HLA antibodies, soluble CD30 levels, and acute rejection six months following renal transplant

Clinical Transplantation, 2009

Specific anti-human leukocyte antigen antibodies (HLA) in the post-transplant period may be prese... more Specific anti-human leukocyte antigen antibodies (HLA) in the post-transplant period may be present with acute rejection episodes (ARE), and high soluble CD30 (sCD30) serum levels may be a risk factor for ARE and graft loss. HLA cross-matching, panel reactive antibodies (PRA), and sCD30 levels were determined prior to transplantation in 72 patients. Soluble CD30 levels and PRA were re-assessed at day 7, 14, 21, and 28, and monthly up to the sixth. Twenty-four subjects had a positive PRA and 17 experienced ARE. Nine of 17 ARE subjects demonstrated positive PRA and 16 had HLA mismatches. Positive PRA was more frequent in ARE subjects (p = 0.03). Eight subjects with ARE had donor-specific antibodies (DSA) in serum samples pre-transplantation, two subjects developed DSA. Three subjects without ARE had positive PRA only in post-transplantation samples. Soluble CD30 levels were higher in pre-transplant samples and ARE subjects than non-ARE subjects (p = 0.03). Post-transplant sCD30 levels were elevated in subjects who experienced rejection and were significantly higher at seven d (p = 0.0004) and six months (p = 0.03). Higher sCD30 levels following transplant were associated with ARE. Elevated sCD30 levels may represent a risk factor for acute rejection.