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449 CAN WE ELIMINATE THE SCREENING VOIDING CYSTOURETHROGRAM IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY?
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THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
to CcRCC lines. Activation of the mTORC1 complex, as measured by phospho-S6 levels, was comparable between TfRCC and CcRCC lines, as were levels of total MET. In contrast, phosphorylated MET and endogenous MET ligand (HGF) were undetectable in TfRCC lines, despite variable expression in CcRCC lines. LY294002 inhibition of Akt activation dramatically reduced proliferation of all TfRCC cell lines, with growth-IC50s of 10-20 M, and mTOR inhibition with sirolimus yielded a ⬎30% growth reduction in 4 of 5 TfRCC cell lines at concentrations of ⬍/⫽ 100 nM. MET inhibition with either PHA665752 or PF02341066 failed to suppress growth at concentrations (up to 1000 nM) well beyond the IC50 for these drugs reported in sensitive cell lines. CONCLUSIONS: The Akt-mTOR pathway is activated in TfRCC cell lines. This activation appears independent of MET signaling as TfRCC lines revealed no evidence of MET activation. Pharmacologic inhibition of Akt and mTOR but not MET effectively suppresses TfRCC growth in vitro, supporting a role for therapeutic targeting of the Akt-mTOR pathway in TfRCC patients. Source of Funding: Departmental
Pediatrics: Congenital Anomalies - Kidney & Ureter Moderated Poster Sunday, May 20, 2012
1:00 PM-3:00 PM
449 CAN WE ELIMINATE THE SCREENING VOIDING CYSTOURETHROGRAM IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY? Beth Drzewiecki*, Douglass Clayton, John Thomas, John Pope, Mark Adams, John Brock, Stacy Tanaka, Nashville, TN INTRODUCTION AND OBJECTIVES: Our understanding of both multicystic dysplastic kidney(MCDK) and vesicoureteral reflux(VUR) has increased significantly over the years and therefore management continues to evolve. While reflux nephropathy in a solitary kidney can be devastating, the natural history of VUR in MCDK is primarily that of resolution. The current guidelines regarding VUR do not address children with a solitary kidney. We sought to determine role of screening VCUG in patients diagnosed with MCDK. METHODS: We retrospectively reviewed the charts of all patients with a diagnosis of MCDK (ICD9 753.19) between January 1, 2000 and July 31, 2010. 210 patients were identified as having a diagnosis of MCDK and only 2 did not have a screening VCUG. Information including gender, screening VCUG, grade of reflux, location of reflux (contralateral vs ipsilateral), febrile UTI, resolution of VUR or surgical intervention, and indication for surgery was obtained. Kaplan-Meier survival analysis was performed to evaluate outcomes of contralateral reflux over time. RESULTS: A total of 208 children (54% male and 46% female) included in the analysis. Documented VUR on either side was found in 51 (25%) of patients. Contralateral VUR was found in 37 (18%) of children with MCDK, of whom 8 had bilateral VUR. Median follow up of patients with contralateral VUR was 30.1 months (range 6.2-97.7). Clinically significant VUR was seen in 3 patients (1.4%) as noted by nephropathy (1) and febrile UTI (2). Nine patients underwent surgical correction for contralateral VUR, one of whom had endoscopic correction only. Indications for surgery included nephropathy (1), febrile UTIs (2), and concern for reflux in solitary kidney (6). Resolution in the children observed was documented by radiologic study in 18, of whom 12 had high grade VUR(grade III-V). Median time to resolution was 16.5 months (range 10.6 to 53). On Kaplan-Meier analysis, there is an 80% likelihood of children not requiring surgical intervention for contralateral VUR at 48 months. CONCLUSIONS: Overall, 208 VCUGs were performed to detect clinically significant VUR in 1.4% of patients. Children with MCDK
and contralateral VUR have a low likelihood of febrile UTI and excellent chance of resolution of even high grade VUR. Abnormal post natal ultrasound should still warrant investigation for VUR. Parents should be cautioned on the risks of UTIs in a solitary kidney and that any febrile illness should warrant urinary evaluation for infection. Source of Funding: None
450 DISPARITIES AND LACK OF CONSENSUS IN THE MANAGEMENT OF CHILDREN WITH PRENATALLY DIAGNOSED MILD HYDRONEPHROSIS: A SURVEY ANALYSIS OF MANAGEMENT PRACTICE BY PEDIATRIC UROLOGISTS, RADIOLOGISTS AND MATERNAL FETAL MEDICINE SPECIALISTS. Vitor C. Zanetta*, Marc Cendron, Jeanne Chow, Boston, MA; Jeffrey B. Campbell, Aurora, CO; Anthony C.D. Herndon, Charlottesville, VA; Bryan Bromley, Thomas D. Shipp, Hiep T. Nguyen, Boston, MA INTRODUCTION AND OBJECTIVES: There are no clear guidelines on the management of mild hydronephrosis (MH). Due to variation in physician approach, it is difficult to analyze outcomes and to theorize the optimal management of these patients. We set out to determine the variability in the diagnosis and management of MH by pediatric urologists, pediatric radiologists, and maternal fetal medicine obstetricians (MFMs). METHODS: Online surveys were sent to mailing lists for national societies of each specialty. Demographic and practice information was recorded. Participants were then surveyed on their diagnosis of MH and their recommendations for antibiotic prophylaxis, work-up scheduling and imaging preferences. Moderate or severe hydronephrosis management was recorded for comparison. RESULTS: 125 pediatric urologists, 109 radiologists, and 311 MFMs responded to the survey. Urologists and radiologists were divided between Society for Fetal Urology criterion (SFU) and the use of anterior posterior pelvic diameter (APD) for determining hydronephrosis, while MFMs clearly preferred using APD. For postnatal evaluation, radiologists preferred to use a personal criterion, while urologists preferred the APD or SFU grading system. There was a wide variation of antibiotic prophylaxis use among urologists. Interestingly, less experience correlated with recommending prophylaxis. Regarding the use of VCUG/ RNC in patients with MH, both urologists and radiologists did not consistent in their recommendations. The optimal US follow up time for prenatal hydronephrosis also had poor agreement. Of note, all results contrasted with much higher agreement for moderate or severe hydronephrosis. CONCLUSIONS: There is little consensus between and within urologists, radiologists and obstetricians on the diagnosis and management of mild hydronephrosis. Uniform management guidelines need to be developed among specialists dealing with children with mild prenatal hydronephrosis. Source of Funding: None
451 DOWN SYNDROME DOES NOT INCREASE THE RISK OF UROLOGICAL ANOMALIES IN CHILDREN Bulent Onal*, Caio M. Oliveira, Jeanne S. Chow, Courtney K. Rowe, Hiep T. Nguyen, Boston, MA INTRODUCTION AND OBJECTIVES: Recent studies suggest that children with Down syndrome have an increased frequency of associated renal and urinary tract anomalies (RUTAs). These conclusions are complicated by the increased likelihood of incidentally discovered RUTAs in this population with a greater rate of radiological examinations. The aim of this study is to assess the rate of RUTAs in patients with Down syndrome who underwent radiologic examinations involving the urinary system and to determine the outcomes of both incidentally discovered and symptomatic RUTAs.
THE JOURNAL OF UROLOGY姞
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
to CcRCC lines. Activation of the mTORC1 complex, as measured by phospho-S6 levels, was comparable between TfRCC and CcRCC lines, as were levels of total MET. In contrast, phosphorylated MET and endogenous MET ligand (HGF) were undetectable in TfRCC lines, despite variable expression in CcRCC lines. LY294002 inhibition of Akt activation dramatically reduced proliferation of all TfRCC cell lines, with growth-IC50s of 10-20 M, and mTOR inhibition with sirolimus yielded a ⬎30% growth reduction in 4 of 5 TfRCC cell lines at concentrations of ⬍/⫽ 100 nM. MET inhibition with either PHA665752 or PF02341066 failed to suppress growth at concentrations (up to 1000 nM) well beyond the IC50 for these drugs reported in sensitive cell lines. CONCLUSIONS: The Akt-mTOR pathway is activated in TfRCC cell lines. This activation appears independent of MET signaling as TfRCC lines revealed no evidence of MET activation. Pharmacologic inhibition of Akt and mTOR but not MET effectively suppresses TfRCC growth in vitro, supporting a role for therapeutic targeting of the Akt-mTOR pathway in TfRCC patients. Source of Funding: Departmental
Pediatrics: Congenital Anomalies - Kidney & Ureter Moderated Poster Sunday, May 20, 2012
1:00 PM-3:00 PM
449 CAN WE ELIMINATE THE SCREENING VOIDING CYSTOURETHROGRAM IN CHILDREN WITH MULTICYSTIC DYSPLASTIC KIDNEY? Beth Drzewiecki*, Douglass Clayton, John Thomas, John Pope, Mark Adams, John Brock, Stacy Tanaka, Nashville, TN INTRODUCTION AND OBJECTIVES: Our understanding of both multicystic dysplastic kidney(MCDK) and vesicoureteral reflux(VUR) has increased significantly over the years and therefore management continues to evolve. While reflux nephropathy in a solitary kidney can be devastating, the natural history of VUR in MCDK is primarily that of resolution. The current guidelines regarding VUR do not address children with a solitary kidney. We sought to determine role of screening VCUG in patients diagnosed with MCDK. METHODS: We retrospectively reviewed the charts of all patients with a diagnosis of MCDK (ICD9 753.19) between January 1, 2000 and July 31, 2010. 210 patients were identified as having a diagnosis of MCDK and only 2 did not have a screening VCUG. Information including gender, screening VCUG, grade of reflux, location of reflux (contralateral vs ipsilateral), febrile UTI, resolution of VUR or surgical intervention, and indication for surgery was obtained. Kaplan-Meier survival analysis was performed to evaluate outcomes of contralateral reflux over time. RESULTS: A total of 208 children (54% male and 46% female) included in the analysis. Documented VUR on either side was found in 51 (25%) of patients. Contralateral VUR was found in 37 (18%) of children with MCDK, of whom 8 had bilateral VUR. Median follow up of patients with contralateral VUR was 30.1 months (range 6.2-97.7). Clinically significant VUR was seen in 3 patients (1.4%) as noted by nephropathy (1) and febrile UTI (2). Nine patients underwent surgical correction for contralateral VUR, one of whom had endoscopic correction only. Indications for surgery included nephropathy (1), febrile UTIs (2), and concern for reflux in solitary kidney (6). Resolution in the children observed was documented by radiologic study in 18, of whom 12 had high grade VUR(grade III-V). Median time to resolution was 16.5 months (range 10.6 to 53). On Kaplan-Meier analysis, there is an 80% likelihood of children not requiring surgical intervention for contralateral VUR at 48 months. CONCLUSIONS: Overall, 208 VCUGs were performed to detect clinically significant VUR in 1.4% of patients. Children with MCDK
and contralateral VUR have a low likelihood of febrile UTI and excellent chance of resolution of even high grade VUR. Abnormal post natal ultrasound should still warrant investigation for VUR. Parents should be cautioned on the risks of UTIs in a solitary kidney and that any febrile illness should warrant urinary evaluation for infection. Source of Funding: None
450 DISPARITIES AND LACK OF CONSENSUS IN THE MANAGEMENT OF CHILDREN WITH PRENATALLY DIAGNOSED MILD HYDRONEPHROSIS: A SURVEY ANALYSIS OF MANAGEMENT PRACTICE BY PEDIATRIC UROLOGISTS, RADIOLOGISTS AND MATERNAL FETAL MEDICINE SPECIALISTS. Vitor C. Zanetta*, Marc Cendron, Jeanne Chow, Boston, MA; Jeffrey B. Campbell, Aurora, CO; Anthony C.D. Herndon, Charlottesville, VA; Bryan Bromley, Thomas D. Shipp, Hiep T. Nguyen, Boston, MA INTRODUCTION AND OBJECTIVES: There are no clear guidelines on the management of mild hydronephrosis (MH). Due to variation in physician approach, it is difficult to analyze outcomes and to theorize the optimal management of these patients. We set out to determine the variability in the diagnosis and management of MH by pediatric urologists, pediatric radiologists, and maternal fetal medicine obstetricians (MFMs). METHODS: Online surveys were sent to mailing lists for national societies of each specialty. Demographic and practice information was recorded. Participants were then surveyed on their diagnosis of MH and their recommendations for antibiotic prophylaxis, work-up scheduling and imaging preferences. Moderate or severe hydronephrosis management was recorded for comparison. RESULTS: 125 pediatric urologists, 109 radiologists, and 311 MFMs responded to the survey. Urologists and radiologists were divided between Society for Fetal Urology criterion (SFU) and the use of anterior posterior pelvic diameter (APD) for determining hydronephrosis, while MFMs clearly preferred using APD. For postnatal evaluation, radiologists preferred to use a personal criterion, while urologists preferred the APD or SFU grading system. There was a wide variation of antibiotic prophylaxis use among urologists. Interestingly, less experience correlated with recommending prophylaxis. Regarding the use of VCUG/ RNC in patients with MH, both urologists and radiologists did not consistent in their recommendations. The optimal US follow up time for prenatal hydronephrosis also had poor agreement. Of note, all results contrasted with much higher agreement for moderate or severe hydronephrosis. CONCLUSIONS: There is little consensus between and within urologists, radiologists and obstetricians on the diagnosis and management of mild hydronephrosis. Uniform management guidelines need to be developed among specialists dealing with children with mild prenatal hydronephrosis. Source of Funding: None
451 DOWN SYNDROME DOES NOT INCREASE THE RISK OF UROLOGICAL ANOMALIES IN CHILDREN Bulent Onal*, Caio M. Oliveira, Jeanne S. Chow, Courtney K. Rowe, Hiep T. Nguyen, Boston, MA INTRODUCTION AND OBJECTIVES: Recent studies suggest that children with Down syndrome have an increased frequency of associated renal and urinary tract anomalies (RUTAs). These conclusions are complicated by the increased likelihood of incidentally discovered RUTAs in this population with a greater rate of radiological examinations. The aim of this study is to assess the rate of RUTAs in patients with Down syndrome who underwent radiologic examinations involving the urinary system and to determine the outcomes of both incidentally discovered and symptomatic RUTAs.