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MP19-20 A PILOT STUDY COMPARING VIRTUAL AND REAL CONSULTATION(OUT PATIENT) FOR STONE PATIENTS FUTURE OF ENDOUROLOGY STONE CLINIC
THE JOURNAL OF UROLOGYâ
e238
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
MP19-19
MP19-20
PATIENTS WITH CALCIUM STONES AND RANDALL’S PLAQUE EXCRETE DISTINCT POPULATIONS OF MICRO RNA-CONTAINING URINARY EXTRACELLULAR VESICLES
A PILOT STUDY COMPARING VIRTUAL AND REAL CONSULTATION(OUT PATIENT) FOR STONE PATIENTS FUTURE OF ENDOUROLOGY STONE CLINIC
John Lieske*, Xiangling Wang, Robin Chirackal, John Knoedler, Rochester, MN; Amy Krambeck, Indianapolis, IN; Felicity Enders, Andrew Rule, Pritha Chanana, Muthuvel Jayachandran, Rochester, MN INTRODUCTION AND OBJECTIVES: Randall’s plaques (RP) appear to be an important precursor of urinary stone disease. However, RP cannot be noninvasively detected. Furthermore, the biologic processes that mediate growth of RP remain unclear. This study was designed to identify specific micro RNA (miRNAs) changes within urinary extracellular vesicles (EVs) based on stone forming status, and the amount of intrarenal RP. METHODS: A total of 40 subjects were included in this study. First time (incident) stone formers and population controls were recruited from the community (n¼10 each). RP were assessed via endoscopic digital imaging with quantitative analysis in consecutive idiopathic calcium oxalate stone formers undergoing percutaneous surgery for stone removal. Subjects with high amounts of RP (HP; > 5% papillary surface area coverage; n¼10) were age (+/- 5 yrs) and sex matched to a group with low amounts of RP (LP; < 5% papillary surface area coverage; n¼10). Small non-coding miRNAs within urinary EVs were quantitated by XRNA Exosome RNA-Seq Library Kit (System Biosciences, Palo Alto, CA). Differentially expressed miRNAs with a p-value of 0.05 or lower were chosen for pathway analysis and miRNA target prediction comparing LP versus HP, and population controls versus stone formers. RESULTS: When controls were compared to stone formers, a total of 10 miRNA were increased (6 to 10-fold), while 5 miRNA were decreased (2 to 5-fold). When LP were compared to HP stone formers, 3 miRNA were increased (6.5 to 10-fold) while 7 miRNA were decreased (6-9 fold). The upregulated miRNAs contribute in calcification, cell proliferation, acute kidney injury, renal fibrosis, pro-apoptotic and pro-inflammatory pathways whereas down-regulated miRNAs contribute anti-apoptotic and anti-inflammatory processes, prevent renal fibrosis, ischemic injury, and progression of chronic kidney disease. CONCLUSIONS: Stone formers and those with high amounts of RP excrete distinct populations of miRNAs within urinary EVs. These miRNAs may serve as novel biomarkers to indicate the presence of RP. These miRNAs may also provide new insights into early renal cellular processes in the progression of stone pathogenesis and RP and new tools for the screening, diagnosis, risk stratification and monitoring of pharmacological therapy for persons with idiopathic stone disease. Further studies to validate and extend these observations are needed. Source of Funding: NIDDK U54 DK100227
Haresh Thummar*, Vadodara, India; Shivang D, New York, India; N Thummar, Nelson Z, vadodara, India INTRODUCTION AND OBJECTIVES: Healthcare professionals are among the last, if not the last, service providers to not use Internet technology to communicate with the people they serve. As much as patients are able to communicate with their doctors, and physicians, medical professionals will also be able to transmit data between each other; overall helping the patients’ well-being. Many a times, its very difficult for patients to come from far places for stone clinic for consultation wasting a lot of time. With increased use of mobile phones, Internet and with increased skill of fast communication through handy available cell phone to almost everyone. Uncomplicated stone patients do not need detail clinical examination most of the time. Can we use these advantages in current era in providing health care at every corner of world without compromising quality of care? We could not find literature to address this issue. Aim of our study was to assess feasibility, reproducibility and accuracy of e-consultation in stone clinic and compare with standard consultation defining good practice and inform its implementation in relation to clinician-patient consultations via whatsapp and similar virtual media. METHODS: We included 30 uncomplicated stone patients who presented to endourology clinic during Jan 2016 to June 2016 according our inclusion criteria. First we did e-consultation using whatsapp and other virtual media and assessed clinical history, biochemical profile and imaging with images and communicated through media and made a provisional diagnosis and decided management plan. Then we did real consultation as standard practice and decided management plan. We compared diagnosis and management plans in this both consultations virtual and real. We graded in five grades according to difference in diagnosis and management plan.We assessed 5 point likert score also for virtual and real consultation. Grade 1 2 3 4 5
Description Minor differences not affecting surgical plan Difference that change in type of procedure Difference that change decision for observation vs. surgery Difference that leads to an additional procedure needed during surgery Difference that result in potentially severe complication
RESULTS: There was no significant difference in diagnosis or management plan in virtual Vs real consultation. There was grade 1 change in 2 patients, grade 2 and 3 change in one patient. Five point likert scale score difference was not significantly difference. CONCLUSIONS: Based on this pilot study, virtual consultation (e-consultation) for kidney stone patients is feasible and accurate in selected group of patients without compromising quality of care. And may be a future of endourology clinic. However, large number of study is required to define its role in future. Source of Funding: none
e238
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
MP19-19
MP19-20
PATIENTS WITH CALCIUM STONES AND RANDALL’S PLAQUE EXCRETE DISTINCT POPULATIONS OF MICRO RNA-CONTAINING URINARY EXTRACELLULAR VESICLES
A PILOT STUDY COMPARING VIRTUAL AND REAL CONSULTATION(OUT PATIENT) FOR STONE PATIENTS FUTURE OF ENDOUROLOGY STONE CLINIC
John Lieske*, Xiangling Wang, Robin Chirackal, John Knoedler, Rochester, MN; Amy Krambeck, Indianapolis, IN; Felicity Enders, Andrew Rule, Pritha Chanana, Muthuvel Jayachandran, Rochester, MN INTRODUCTION AND OBJECTIVES: Randall’s plaques (RP) appear to be an important precursor of urinary stone disease. However, RP cannot be noninvasively detected. Furthermore, the biologic processes that mediate growth of RP remain unclear. This study was designed to identify specific micro RNA (miRNAs) changes within urinary extracellular vesicles (EVs) based on stone forming status, and the amount of intrarenal RP. METHODS: A total of 40 subjects were included in this study. First time (incident) stone formers and population controls were recruited from the community (n¼10 each). RP were assessed via endoscopic digital imaging with quantitative analysis in consecutive idiopathic calcium oxalate stone formers undergoing percutaneous surgery for stone removal. Subjects with high amounts of RP (HP; > 5% papillary surface area coverage; n¼10) were age (+/- 5 yrs) and sex matched to a group with low amounts of RP (LP; < 5% papillary surface area coverage; n¼10). Small non-coding miRNAs within urinary EVs were quantitated by XRNA Exosome RNA-Seq Library Kit (System Biosciences, Palo Alto, CA). Differentially expressed miRNAs with a p-value of 0.05 or lower were chosen for pathway analysis and miRNA target prediction comparing LP versus HP, and population controls versus stone formers. RESULTS: When controls were compared to stone formers, a total of 10 miRNA were increased (6 to 10-fold), while 5 miRNA were decreased (2 to 5-fold). When LP were compared to HP stone formers, 3 miRNA were increased (6.5 to 10-fold) while 7 miRNA were decreased (6-9 fold). The upregulated miRNAs contribute in calcification, cell proliferation, acute kidney injury, renal fibrosis, pro-apoptotic and pro-inflammatory pathways whereas down-regulated miRNAs contribute anti-apoptotic and anti-inflammatory processes, prevent renal fibrosis, ischemic injury, and progression of chronic kidney disease. CONCLUSIONS: Stone formers and those with high amounts of RP excrete distinct populations of miRNAs within urinary EVs. These miRNAs may serve as novel biomarkers to indicate the presence of RP. These miRNAs may also provide new insights into early renal cellular processes in the progression of stone pathogenesis and RP and new tools for the screening, diagnosis, risk stratification and monitoring of pharmacological therapy for persons with idiopathic stone disease. Further studies to validate and extend these observations are needed. Source of Funding: NIDDK U54 DK100227
Haresh Thummar*, Vadodara, India; Shivang D, New York, India; N Thummar, Nelson Z, vadodara, India INTRODUCTION AND OBJECTIVES: Healthcare professionals are among the last, if not the last, service providers to not use Internet technology to communicate with the people they serve. As much as patients are able to communicate with their doctors, and physicians, medical professionals will also be able to transmit data between each other; overall helping the patients’ well-being. Many a times, its very difficult for patients to come from far places for stone clinic for consultation wasting a lot of time. With increased use of mobile phones, Internet and with increased skill of fast communication through handy available cell phone to almost everyone. Uncomplicated stone patients do not need detail clinical examination most of the time. Can we use these advantages in current era in providing health care at every corner of world without compromising quality of care? We could not find literature to address this issue. Aim of our study was to assess feasibility, reproducibility and accuracy of e-consultation in stone clinic and compare with standard consultation defining good practice and inform its implementation in relation to clinician-patient consultations via whatsapp and similar virtual media. METHODS: We included 30 uncomplicated stone patients who presented to endourology clinic during Jan 2016 to June 2016 according our inclusion criteria. First we did e-consultation using whatsapp and other virtual media and assessed clinical history, biochemical profile and imaging with images and communicated through media and made a provisional diagnosis and decided management plan. Then we did real consultation as standard practice and decided management plan. We compared diagnosis and management plans in this both consultations virtual and real. We graded in five grades according to difference in diagnosis and management plan.We assessed 5 point likert score also for virtual and real consultation. Grade 1 2 3 4 5
Description Minor differences not affecting surgical plan Difference that change in type of procedure Difference that change decision for observation vs. surgery Difference that leads to an additional procedure needed during surgery Difference that result in potentially severe complication
RESULTS: There was no significant difference in diagnosis or management plan in virtual Vs real consultation. There was grade 1 change in 2 patients, grade 2 and 3 change in one patient. Five point likert scale score difference was not significantly difference. CONCLUSIONS: Based on this pilot study, virtual consultation (e-consultation) for kidney stone patients is feasible and accurate in selected group of patients without compromising quality of care. And may be a future of endourology clinic. However, large number of study is required to define its role in future. Source of Funding: none