More than 100 trillion microbial cells that reside in the human gut heavily influence nutrition, metabolism and immune function of the host. Gut dysbiosis, seen commonly in patients with Chronic Kidney Disease (CKD), results from qualitative and quantitative changes in host microbiome profile and disruption of gut barrier function. Alterations in gut microbiota and a myriad of host responses have been implicated in progression of CKD, increased cardiovascular risk, uremic toxicity and inflammation. We present a discussion of dysbiosis, various uremic toxins produced from dysbiotic gut microbiome, and their roles in CKD progression and complications. We also review the gut microbiome in renal transplant, highlighting the role of commensal microbes in alteration of immune responses to transplantation, and conclude with therapeutic interventions that aim to restore intestinal dysbiosis.

Preclinical and clinical studies continue to enhance our insights into the complex biology of TGCTs, and are helping to further refine risk stratification and optimize treatment of patients with TGCTs.

Treatment paradigms continue to be refined for TGCTs as research in these areas continues.

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210 Background: The purpose of this pilot study is to describe the time interval from diagnosis to initial specialist visit and treatment initiation in pts with newly diagnosed PC across different clinical stages (S1- 4) in an equal access system such as a Veterans Affairs Medical Center (VAMC). Methods: Data from the Baltimore VAMC database were used to examine pts diagnosed with PC in 2010 to assess variation across different clinical stages with respect to follow up with specialists, diagnostic tests and treatment initiation during the year following diagnosis. Specialists include urologists, medical oncologists and radiation oncologists. Diagnostic tests included CT and/or bone scans. Treatments based on clinical staging included active surveillance, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, chemotherapy or enrollment into clinical trials. Results: One hundred and nine pts were diagnosed with PC at the BVAMC in 2010. All but one patient had follow-up with a specialist after positive prostate biopsy. Majority of pts in each stage saw more than one specialist (S1-50%, S2-74%, S3-60%, S4-82%). The median number of days to first follow up visit with a specialist was similar across all stages (S1-16 d, S2-15 d, S3-17 d, S4-14 d). Four out of the 109 pts were lost to follow up. S4 pts were initiated on treatment at a median of 26 days after diagnosis, whereas S1, S2 and S3 pts were initiated on treatment at a median of 151,100 and135 days respectively, after diagnosis. Pretreatment CT scan and/or bone scans were done in S1-38%, S2 -70%, S3-80% and S4-100% pts. Conclusions: The results of this pilot study showed that while time to initial follow up visit after diagnosis of PC does not differ across the clinical stages, treatment for S4 pts is initiated much earlier than for the other stages. It will be of interest to determine whether these patterns hold for other years and in other VA Medical Centers.