Value of the ICCS screening tool for patient subtyping S.Karamaria, C. Van Herzeele, J. Vande Walle Department of Paediatric Nephrology/Urology Value of the ICCS screening tool for patient subtyping

ICCS Standardization Reports

ICCS Screening Tool: literature

ICCS Screening Tool: literature International consensus Diagnosis and management of enuresis in primary care Value?

ICCS Screening Tool Basic Optimal Vande Walle et al. 2012

ICCS Screening Tool: diaries 3-4 days (weekend/holiday) Time Volume of drinks (mL) Urinary volume (mL) Leakage of urine? 7 consecutive nights Bedtime Wake up time Dry or wet night? Diaper weight in the morning (net) Volume of first morning void Volume of nocturia void? Bowel movement during the day? nocturnal urine production www.i-c-c-s.org Vande Walle et al. 2012 Van Herzeele et al. 2015

ICCS Screening Tool: treatment choices Desmopressin or enuresis alarm Basic Optimal Normal MVV Reduced MVV Normal nocturnal diuresis alarm OR desmopressin alarm Nocturnal polyuria desmopressin alarm and desmopressin Screening + family preference and motivation Vande Walle et al. 2012

ICCS Screening Tool: predictive value urgency 87% sensitivity frequency postponing only 13% of the patients with LUTS or comorbidities missed New ICCS definitions: 25.3% MNE Old ICCS definitions: 52.2% MNE Vande Walle et al. 2012/2013

ICCS Screening Tool: Example: DRIP study DRIP = Desmopressin Response in the treatment of PNE Re-analysis: ‘do screening parameters predict response to desmopressin?’

ICCS Screening Tool: Example: re-analysis DRIP study Demographic predictors: gender, weight, BMI, family history, country, age (p<.001) Van Herzeele et al. 2015

ICCS Screening Tool: Example: re-analysis DRIP study Demographic predictors: gender, weight, BMI, family history, country, age (p<.001) Enuretic predictors: number of wet nights per week (p<.0001), nocturnal diuresis, MVV Van Herzeele et al. 2015

ICCS Screening Tool: Example: re-analysis DRIP study Demographic predictors: gender, weight, BMI, family history, country, age (p<.001) Enuretic predictors: number of wet nights per week, nocturnal diuresis (p<.0001), MVV Van Herzeele et al. 2015

Response to desmopressin: DRIP (40%) ↔ initial papers (50-60%) ICCS Screening Tool: Example: re-analysis DRIP study Demographic predictors: gender, weight, BMI, family history, country, age (p<.001) Enuretic predictors: number of wet nights per week, nocturnal diuresis, MVV (p<.0001) Response to desmopressin: DRIP (40%) ↔ initial papers (50-60%) Patient selection! Van Herzeele et al. 2015

ICCS Screening Tool: Example: re-analysis DRIP study Demographic predictors: gender, weight, BMI, family history, country, age (p<.001) Enuretic predictors: number of wet nights per week, nocturnal diuresis, MVV (p<.0001) >80% 6.98% 9.63% 3.16% Van Herzeele et al. 2015

ICCS Screening Tool: conclusions Raises awareness Provides current information to the family and the physician Detects children with NMNE and children that need extra evaluation Helps choose the most appropriate therapy Provides prognostic information for the response to treatment Overrides false advise and misinformation from unregulated sources Limits recommendations to evidence based treatment strategies

Sevasti karamaria Trainee in Paediatric Nephrology