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INTRAOPERATIVE VISUAL ASSESSMENT AS A PREDICTOR OF RENAL FUNCTION AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
intensity change from the baseline to peak ($I), and $I / TTP of the tumor and the normal parenchyma were measured from the time-intensity curve and compared statistically (Fig. 1A). RESULTS: The pathologic diagnosis included renal cell carcinoma (n=11), and hemorrhagic cyst (n=1). TTP of the cancer was significantly shorter than the normal parenchyma(mean seconds [s] ±SD: 6.4±1.6 vs. 10.9±3.1; p<0.0001). There was no $I difference between the cancer and normal parenchyma (mean decibels [db] ±SD: 23.5±4.6 vs. 19.5±7; p=0.0503); $I / TTP of the cancer was significantly higher than the normal parenchyma (mean db/s±SD: 3.9±1.1 vs. 1.9±0.9; p=0.0003). The intensity of the hemorrhagic cyst did not change from the baseline intensity (Fig 1B). CONCLUSIONS: Contrast-enhanced ultrasound using a timeintensity curve is a promising tool in the diagnosis and differentiation of complex cystic renal masses.
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partial nephrectomy, intraoperative visual assessment of residual renal parenchyma is a reasonably accurate means of determining postoperative renal function, as validated by renal scintigraphy. Source of Funding: None
Pediatrics: Basic Research Moderated Poster 24 Monday, April 27, 2009
8:00 am - 10:00 am
702 LIQUID CHROMATOGRAPHY/MASS SPECTROMETRY URINARY PROTEOME ANALYSIS DISCRIMINATES BETWEEN HEALTHY INFANTS AND AGE MATCHED PATIENTS WITH UNILATERAL GRADE 4 URETEROPELVIC JUNCTION OBSTRUCTION. Hrair-George O Mesrobian*, Tao Wang, Brian Halligan, Bassam T Wakim, Milwaukee, WI
Source of Funding: None
701 INTRAOPERATIVE VISUAL ASSESSMENT AS A PREDICTOR OF RENAL FUNCTION AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY Andrea A Chan*, Juan Caicedo, Mark F Munsell, Surena F Matin, Houston, TX INTRODUCTION AND OBJECTIVE: To determine predictors of post-operative renal function of the operated kidney after laparoscopic and open nephron-sparing surgery. METHODS: A total of 215 patients with renal tumor who underwent partial nephrectomy from August 2002 to June 2007 were assessed. Patients were evaluated based on surgical approach (laparoscopic versus open partial nephrectomy). Factors including patient age, indication for nephron-sparing, approach of nephron-sparing, pre-operative and postoperative creatinine clearance, radiographic tumor size, pathologic tumor size, tumor depth, ischemic time, and residual renal volume estimated intraoperatively were evaluated as potential predictors for post-operative renal function in the ipsilateral kidney. The correlation of each potential predictor to actual post-operative split renal function, as determined by MAG3 renal scintigraphy performed at the first post-operative follow up, was calculated. Statistical analysis including linear regression and and correlation analysis were performed using commercially available software. Results are considered significant if p<0.05. RESULTS: Patient age, indication for nephron sparing, preoperative creatinine clearance, and post-operative creatinine clearance did not correlate significantly with post-operative renal function of the operated kidney. In univariate regression analysis the only factors found to be significantly related to post-operative renal scan function were estimated function (p<0.001) and procedure (p=0.021). Ischemia time (p=0.072) and depth of tumor (p=0.050) were borderline statistically significantly related to post-operative renal scan function. In addition, there was marginal correlation between tumor size and renal function prediction. CONCLUSIONS: Open surgical approach, depth of tumor, and ischemic time all have intermediate prognostic value in estimating postoperative split renal function. Visually estimated renal volume intraoperatively was the most accurate predictor of the actual split renal function in our study. During both laparoscopic and open
INTRODUCTION AND OBJECTIVE: Prenatally detected ureteropelvic junction obstruction (UPJO) may over time progress and require surgery, improve or remain stable and it may take upwards of 3 years for its natural history to unfold. Urinary proteome analysis utilizing capillary electrophoresis-mass spectrometry (CE-MS) has been shown to discriminate between normal infants and patients with UPJO. We sought to confirm these findings utilizing liquid chromatography/ mass spectrometry (LC-MS/MS)-which in addition allows for amino acid sequence information of the individual urinary proteins-in a group of patients with grade 4 UPJO. METHODS: 34 urine specimens from healthy infants-with normal maternal/fetal ultrasound- and 21 with grade 4 UPJO were obtained. Once the urine was assessed to be clean and free of bacteria, the specimens were centrifuged to remove particulate material and cells, aliquoted and stored in a -80°C freezer until analysis. A typical proteomics experiment consists of concentrating the urine specimen, immobilizing the proteins into a polyacrylamide gel piece, digesting the proteins with trypsin, extracting the peptides and analyzing them using an LTQ nanospray-LC/ MS. Statistical analysis was performed by applying 2-sided non-parametric Kruskal-Wallis rank-sum statistical tests for the comparison with exact p-values calculated using Markov chain techniques. To adjust for multiple testing, we chose a threshold of 0.001 for declaring significance. (SAS software version 9.1 was used -SAS Institute, Cary, NC). RESULTS: Our results demonstrate that a matrix of 44 urinary proteins differentiates patients with grade 4 UPJO from normal healthy infant volunteers after adjusting for age. A predictive statistical model for grade 4 UPJO based on the individual urinary proteome profile is generated, with a sensitivity and specificity approaching 80%. CONCLUSIONS: LC-MS/MS of urinary specimens discriminates between patients with grade 4 UPJO and normal infants with a high sensitivity and specificity. This valuable tool is being utilized in prospectively validating a matrix of proteins as biomarkers of UPJO and in addition in selecting out early on in infancy, those individuals whose disease is likely to progress over time. The precise identification of the upregulated and downregulated proteins and their function may allow us to understand molecular pathways of disease progression or resolution in infants with UPJO. Source of Funding: CSTI
703 IDENTIFICATION OF NOVEL URINARY BIOMARKERS OF RENAL OBSTRUCTION USING TEMPORAL QUANTITATIVE PROTEOMICS Alireza Vaezzadeh, Andrew C Briscoe, Lee Dicker, Oliver Hofman, Winston Hide, Hanno Steen, Richard S Lee*, Boston, MA INTRODUCTION AND OBJECTIVE: To date, many controversies exist in the detection, prognosis, and proper management of children with hydronephrosis and renal obstruction. During renal obstruction the
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
intensity change from the baseline to peak ($I), and $I / TTP of the tumor and the normal parenchyma were measured from the time-intensity curve and compared statistically (Fig. 1A). RESULTS: The pathologic diagnosis included renal cell carcinoma (n=11), and hemorrhagic cyst (n=1). TTP of the cancer was significantly shorter than the normal parenchyma(mean seconds [s] ±SD: 6.4±1.6 vs. 10.9±3.1; p<0.0001). There was no $I difference between the cancer and normal parenchyma (mean decibels [db] ±SD: 23.5±4.6 vs. 19.5±7; p=0.0503); $I / TTP of the cancer was significantly higher than the normal parenchyma (mean db/s±SD: 3.9±1.1 vs. 1.9±0.9; p=0.0003). The intensity of the hemorrhagic cyst did not change from the baseline intensity (Fig 1B). CONCLUSIONS: Contrast-enhanced ultrasound using a timeintensity curve is a promising tool in the diagnosis and differentiation of complex cystic renal masses.
251
partial nephrectomy, intraoperative visual assessment of residual renal parenchyma is a reasonably accurate means of determining postoperative renal function, as validated by renal scintigraphy. Source of Funding: None
Pediatrics: Basic Research Moderated Poster 24 Monday, April 27, 2009
8:00 am - 10:00 am
702 LIQUID CHROMATOGRAPHY/MASS SPECTROMETRY URINARY PROTEOME ANALYSIS DISCRIMINATES BETWEEN HEALTHY INFANTS AND AGE MATCHED PATIENTS WITH UNILATERAL GRADE 4 URETEROPELVIC JUNCTION OBSTRUCTION. Hrair-George O Mesrobian*, Tao Wang, Brian Halligan, Bassam T Wakim, Milwaukee, WI
Source of Funding: None
701 INTRAOPERATIVE VISUAL ASSESSMENT AS A PREDICTOR OF RENAL FUNCTION AFTER OPEN AND LAPAROSCOPIC PARTIAL NEPHRECTOMY Andrea A Chan*, Juan Caicedo, Mark F Munsell, Surena F Matin, Houston, TX INTRODUCTION AND OBJECTIVE: To determine predictors of post-operative renal function of the operated kidney after laparoscopic and open nephron-sparing surgery. METHODS: A total of 215 patients with renal tumor who underwent partial nephrectomy from August 2002 to June 2007 were assessed. Patients were evaluated based on surgical approach (laparoscopic versus open partial nephrectomy). Factors including patient age, indication for nephron-sparing, approach of nephron-sparing, pre-operative and postoperative creatinine clearance, radiographic tumor size, pathologic tumor size, tumor depth, ischemic time, and residual renal volume estimated intraoperatively were evaluated as potential predictors for post-operative renal function in the ipsilateral kidney. The correlation of each potential predictor to actual post-operative split renal function, as determined by MAG3 renal scintigraphy performed at the first post-operative follow up, was calculated. Statistical analysis including linear regression and and correlation analysis were performed using commercially available software. Results are considered significant if p<0.05. RESULTS: Patient age, indication for nephron sparing, preoperative creatinine clearance, and post-operative creatinine clearance did not correlate significantly with post-operative renal function of the operated kidney. In univariate regression analysis the only factors found to be significantly related to post-operative renal scan function were estimated function (p<0.001) and procedure (p=0.021). Ischemia time (p=0.072) and depth of tumor (p=0.050) were borderline statistically significantly related to post-operative renal scan function. In addition, there was marginal correlation between tumor size and renal function prediction. CONCLUSIONS: Open surgical approach, depth of tumor, and ischemic time all have intermediate prognostic value in estimating postoperative split renal function. Visually estimated renal volume intraoperatively was the most accurate predictor of the actual split renal function in our study. During both laparoscopic and open
INTRODUCTION AND OBJECTIVE: Prenatally detected ureteropelvic junction obstruction (UPJO) may over time progress and require surgery, improve or remain stable and it may take upwards of 3 years for its natural history to unfold. Urinary proteome analysis utilizing capillary electrophoresis-mass spectrometry (CE-MS) has been shown to discriminate between normal infants and patients with UPJO. We sought to confirm these findings utilizing liquid chromatography/ mass spectrometry (LC-MS/MS)-which in addition allows for amino acid sequence information of the individual urinary proteins-in a group of patients with grade 4 UPJO. METHODS: 34 urine specimens from healthy infants-with normal maternal/fetal ultrasound- and 21 with grade 4 UPJO were obtained. Once the urine was assessed to be clean and free of bacteria, the specimens were centrifuged to remove particulate material and cells, aliquoted and stored in a -80°C freezer until analysis. A typical proteomics experiment consists of concentrating the urine specimen, immobilizing the proteins into a polyacrylamide gel piece, digesting the proteins with trypsin, extracting the peptides and analyzing them using an LTQ nanospray-LC/ MS. Statistical analysis was performed by applying 2-sided non-parametric Kruskal-Wallis rank-sum statistical tests for the comparison with exact p-values calculated using Markov chain techniques. To adjust for multiple testing, we chose a threshold of 0.001 for declaring significance. (SAS software version 9.1 was used -SAS Institute, Cary, NC). RESULTS: Our results demonstrate that a matrix of 44 urinary proteins differentiates patients with grade 4 UPJO from normal healthy infant volunteers after adjusting for age. A predictive statistical model for grade 4 UPJO based on the individual urinary proteome profile is generated, with a sensitivity and specificity approaching 80%. CONCLUSIONS: LC-MS/MS of urinary specimens discriminates between patients with grade 4 UPJO and normal infants with a high sensitivity and specificity. This valuable tool is being utilized in prospectively validating a matrix of proteins as biomarkers of UPJO and in addition in selecting out early on in infancy, those individuals whose disease is likely to progress over time. The precise identification of the upregulated and downregulated proteins and their function may allow us to understand molecular pathways of disease progression or resolution in infants with UPJO. Source of Funding: CSTI
703 IDENTIFICATION OF NOVEL URINARY BIOMARKERS OF RENAL OBSTRUCTION USING TEMPORAL QUANTITATIVE PROTEOMICS Alireza Vaezzadeh, Andrew C Briscoe, Lee Dicker, Oliver Hofman, Winston Hide, Hanno Steen, Richard S Lee*, Boston, MA INTRODUCTION AND OBJECTIVE: To date, many controversies exist in the detection, prognosis, and proper management of children with hydronephrosis and renal obstruction. During renal obstruction the