Graduated in Medicine at University of São Paulo, Brazil, in 2005, specialised in Nephrology at Hospital das Clínicas, University of São Paulo School of Medicine. PhD in Nephrology obtained in 2015, currently in a Post-Doctorate Fellowship at Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
Pre-operative kidney functional REServe and damage biomarkers in PrEdiCTion of perioperative acute kidney injury (AKI) after cardiac surgery (The RESPECTAKI Study)
This is an observational study of acute kidney injury in adult patients undergoing heart surgery. The study will evaluate if pre-operative kidney functional reserve (KFR), the extent to which the kidney can increase filtration from baseline after an oral (liquid) protein meal, can predict AKI. The study will also use novel damage biomarkers to detect AKI immediately after surgery. Preoperative KFR will be assessed by blood and urine tests and assessed by the standard creatinine clearance, and compared to two novel methods, namely cystatin C and proenkephalin-A. Blood and urine samples will be collected on first three postoperative days. Patients will be further assessed 1 and 3 months after heart surgery, and a postoperative KFR test will be offered 3 months postoperatively. We expect that KFR and biomarkers will provide timely prediction and diagnosis of AKI.
Preoperative Kidney Functional Reserve in Patients Undergoing Nephrectomy as a Predictor of Long-Term Renal Outcome (PREDICT Study)
Removal of one kidney or part of it can lead to immediate loss of some kidney function; this is usually compensated for by the remaining kidney. We hypothesize, that the degree of compensation can be predicted from the preoperative KFR, the extent to which the kidney can increase filtration from baseline after an oral (liquid) protein meal. We do not know if postoperative compensation, which usually increases estimated glomerular filtration rate over time (after surgery), results from “using up” KFR in the remaining kidney, or from compensatory hypertrophy of structure and function. Patients undergoing partial or total nephrectomy will be assessed by preoperative KFR (measured by three methods: creatinine clearance, cystatin C and proenkephalin-A) and by a novel biomarker, urinary DKK3 levels. This study will evaluate the role of KFR and urine DKK3 in predicting long term kidney function after partial or total nephrectomy, and detect loss of functional reserve after 1 month and 3 months postoperatively.
Detecting Kidney Transplant Calcineurin Inhibitor Toxicity (the TransTox Study)
Kidney transplant recipients need immunosuppressive drugs to avoid organ rejection. Some of these may produce kidney toxicity. Novel urinary damage biomarkers can detect kidney toxicity in the absence of a change in serum creatinine and regardless of blood drug levels. This study will evaluate prospectively the role of more precise and reliable markers of kidney function (serum cystatin C and serum proenkephalin) and of urinary damage biomarkers (KIM-1, calbindin, clusterin, GSTp, IL18 and MCP1) in the diagnosis of kidney toxicity. Novel biomarkers of transplant rejection (urinary CXCL9 and urinary CXCL10) will also be assayed and performance in detecting rejection will be evaluated in the subcohort of patients undergoing kidney biopsy. Additional blood and urine samples will be collected daily for up to 30 days after transplantation, during routine blood collection.