David S. Sharp

Attitudes Of Pediatric Urologists Regarding Sports Participation By Children With A Solitary Kidney

PURPOSE Little data are available regarding sports participation and appropriate long-term followup of children with a solitary kidney. We determine the current practice patterns and recommendations among pediatric urologists regarding sports participation and followup of these patients. MATERIALS AND METHODS A survey was mailed to the 231 active members of the American Academy of Pediatrics, Section on Urology. The survey included questions regarding counseling of patients with a solitary kidney and physician estimates of long-term risk to overall renal function. RESULTS Of the 231 surveys 182 were returned for an overall response rate of 79%. Of the respondents 68% recommend that patients with a solitary kidney avoid contact sports. Recommendations in regard to participation in contact sports were further stratified as strongly against participation (27%), against participation with rare exceptions (30%), no recommendation either way (14%), allow participation (25%) and no restrictions be made (4%). Of the respondents 88% agreed that the estimated risk of renal loss from a child participating regularly in contact sports is less than 1% and 60% recommended special medical followup. CONCLUSIONS Despite the consensus that the risk of renal injury in contact sports is low, a significant number of pediatric urologists advise avoidance. There appears to be a lack of consensus regarding long-term medical surveillance of these patients. Studies designed to obtain accurate clinical data regarding these issues are warranted to establish evidence based guidelines for the long-term treatment of children with a solitary kidney.

MP75-14 ROLE OF NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA IN THE SETTING OF VENOUS TUMOR THROMBUS

follow-up. Our aim was to analyze and compare the incidence of CE after RN and donor nephrectomy (DN) according to an estimated glomerular filtration rate (eGFR) using a matched pair cohort. METHODS: Follow-up for CE (onset of hypertension [aH], stroke or myocardial infarction [MI]) and renal function was collected for all patients after RN and DN who underwent surgery at our department from 1992 to 2007. All patients following DN (n1⁄430) were matched for age to patients treated by RN. Patients with comorbidities were excluded from the analysis. eGFR was estimated preoperatively and at time of follow-up using the Cockgroft Gould formula. RESULTS: 30 kidney donors with a median age 48.9 years (IQR 46-56) and a median follow-up of 138.5 months (IQR 119-159) were matched to 30 RCC patients with a median of 53 years (IQR 4657) and a median follow-up of 151 months (IQR 143-177). There were no significant differences in preoperative eGFR, age and follow-up time between the groups (p>0.5). After RN 12 patients (40%) reported a newly diagnosed and treated aH compared to 14 patients (46.7%) after DN. The incidence of arterial hypertension (aH) was comparable (p1⁄40.79). 6/30 patients after RN developed a CE (six MI and two strokes) and 4/30 patients (three MI, one stroke) after DN (p>0.05). The CE occurred after a median time of 68 months (5-231) and were related to a drop of ~30% in the eGFR irrespective of the group. No patient died or developed end-stage renal disease after the end of follow-up. CONCLUSIONS: Decline of renal function after nephrectomy is the main risk factor for CE. Patients after RN had a higher rate of CE compared to DN patients emphasizing a potential role of RCC. Close monitoring of renal function and the immediate treatment of a new onset of hypertension are warranted