School urinalysis screening in Korea

Safety of deer antler extract in children: A 12-week randomized controlled clinical trial

BACKGROUND

Deer antlers have been used as strong tonifying medicine in Asian countries, especially for the growth and development of children in pediatrics of Korean medicine. The safety of deer antler in adults cannot be applied directly to children because of their physiological characteristics. To accumulate reliable data on the safety of deer antler in pediatric populations, well-designed clinical studies are required.

METHODS

This research is a 12-week, randomized, double-blind, placebo-controlled clinical trial evaluating the safety of deer antler extract (DAE) in children. The DAE group received an intervention containing 1586 mg of DAE, whereas the control group received a placebo for 12 weeks. The safety was assessed by monitoring adverse drug reactions (ADRs) and laboratory test results.

RESULTS

One hundred participants were included in the safety analysis. Three and 2 participants in the DAE and control groups, respectively, reported ADRs. There was no significant difference in incidence between the 2 groups. ADRs are categorized into gastrointestinal and skin-related symptoms. No serious ADR was observed throughout the study. The laboratory test results were within or outside the normal range at clinically insignificant levels.

CONCLUSION

The research discovered that the DAE is safe in terms of ADRs and laboratory parameters under the conditions studied. Further studies are required to accumulate safety data about DAE dosage adjustment and potential interactions with other medicines.

Ethnicity and IgA nephropathy: worldwide differences in epidemiology, timing of diagnosis, clinical manifestations, management and prognosis

Immunoglobulin A nephropathy (IgAN), the most common primary glomerulonephritis, is one of the major causes of end-stage renal disease. Significant variances in epidemiology, clinical manifestation, timing of diagnosis, management and renal prognosis of IgAN have been reported worldwide. The incidence of IgAN is the most frequent in Asia, followed by Europe, and lower in Africa. Moreover, Asian patients show more frequent acute lesions in renal histology and present poorer renal outcomes compared with Caucasians. The comorbidities also show the difference between Asians and Caucasians. Although the frequency of gross hematuria with upper respiratory tract infection is not different, comorbidities with gastrointestinal diseases are reported to be higher in Europe. Recently, genetic studies for variant ethnic patients revealed widely ranging genetic risks in each ethnicity. A genetic risk score is most elevated in Asians, intermediate in Europeans and lowest in Africans, consistent with the disease prevalence of IgAN globally. Ethnic variance might be highly affected by the difference in genetic background. However, it is also essential to mention that the different timing of diagnosis due to variant urinary screening systems and the indication for renal biopsy in different countries may also contribute to these variances. The management of IgAN also varies internationally. Currently, several novel therapies based on the pathogenesis of IgAN are being assessed and are expected to become available soon. Further understanding the ethnic variance of IgAN might help establish individualized care for this disease. Here, we review the issues of ethnic heterogeneities of IgAN.

The incidence and prevalence of IgA nephropathy in Europe

BACKGROUND

This study aimed to determine the incidence and prevalence of immunoglobulin A nephropathy (IgAN) in Europe based on high-quality data from national registries.

METHODS

IgAN incidences were obtained from a literature review of European studies of national kidney biopsy registry data in which IgAN diagnosis was biopsy-verified using contemporary techniques. Studies were eligible for the main analysis if published from 1990 to 2020. IgAN point prevalence was defined as the annual IgAN incidence multiplied by the estimated duration of disease. Incidence and prevalence estimates were made for three pooled populations: (i) patients of all ages; (ii) pediatric patients; and (iii) elderly patients.

RESULTS

Across 10 European countries, the estimated annual IgAN incidence was 0.76 per 100 000 in patients of all ages. The corresponding pooled IgAN point prevalence was 2.53 per 10 000 (95% confidence interval: 2.51-2.55), ranging from 1.14 per 10 000 in Spain to 5.98 per 10 000 in Lithuania. Applied to 2021 population estimates, the number of expected prevalent IgAN cases was 47 027 across all 10 countries and ranged from 577 in Estonia to 16 645 in Italy. Among pediatric patients, IgAN incidence was 0.20 per 100 000 children and IgAN point prevalence was 0.12 per 10 000 children. Among elderly patients, IgAN incidence was 0.30 per 100 000 and IgAN point prevalence was 0.36 per 10 000.

CONCLUSIONS

Based on high-quality data from European national registries, IgAN point prevalence was estimated at 2.53 per 10 000 in patients of all ages. Prevalence was considerably lower in pediatric and elderly populations.

Urine Screening and 9 Years' Medical Record System Follow-Up Among School Students in Wenzhou, China

School urinary screening programming can be useful for the early detection of renal and urinary disorders. However, urine screening is not included in the school health check-up in our region. Therefore, from February 2012 to March 2021, 12,497 school students were screened for urinalysis, and a long-term follow-up took place via an electronic medical record system. Among these screened students, 719 (5.75%) positive individuals received a repeat urinalysis 2 weeks later. During the 9-year medical record system follow-up period, 5 children had renal biopsies and 2 children had a diagnosis of IgA nephropathy (IgAN), while the remaining 3 children were diagnosed with thin basement membrane disease (TBM), primary nephrotic syndrome (PNS), and were suspected of C3 glomerulopathy, respectively. By this, calling for the school urine screening program as a physical examination item for primary and secondary school-aged students will contribute to enabling early detection of urine abnormalities and allow for early treatment.

Uptake of further investigations following universal urinary screening among elementary and junior high school students in Shiga Prefecture, Japan: A retrospective cohort study

AIM

This study aimed to investigate the current progression status from screening phase to further investigation phase in the Japanese school urine mass screening (SUS) project.

METHODS

This retrospective cohort study on the SUS project across the Shiga Prefecture during 2012 to 2017 analysed data from school life instruction sheets, which are principal documents in the SUS project, regarding urinalysis, attendance at follow-up and diagnoses.

RESULTS

Between the years 2012 to 2017, a median of 107 out of 83 749 elementary school students (aged 6-11 years) and 215 out of 42 870 junior high students (aged 12-14 years) had urine abnormalities identified for the first time in the SUS project. Among those with urine abnormalities, a mean of 4.2% of elementary school and 1.8% of junior high school students, respectively, were diagnosed with suspected glomerulonephritis for the first time. Overall, 5.9% (95% confidence interval [CI] 4.1, 7.7) and 23.6% (95% CI 21.3, 25.9) of proteinuria-positive elementary and junior high school students, respectively, did not undergo further investigations. The probability of a student undergoing further investigations was not affected by the local availability of medical care benefits.

CONCLUSION

In the current SUS project, screening frequently does not lead to further investigation, especially among junior high school students. To maintain the integrity of the SUS project and to prevent the progression of renal disease in young students, efforts including elucidation of barriers to further investigations should be made to reduce the proportions of students not undergoing further investigations for abnormal urinalysis findings.

Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study

Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan. Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined. Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students. Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.

Individual and Environmental Factors Associated with Proteinuria in Korean Children: A Multilevel Analysis

Proteinuria is a significant sign of childhood renal disorders. However, little is known about how sociodemographic and environmental factors are related to the presence of proteinuria among children and adolescents. This paper focuses on the prevalence of proteinuria and its risk factors among children and adolescents. This study conducted a secondary analysis of data from the 2016 Sample Schools Raw Data of Health Examination for School Students (SSRDHESS). Data collected from 27,081 students who had undergone a health screening were analyzed using Chi-square tests, independent t-tests, and multilevel logistic regression analysis. The prevalence of proteinuria was higher in the thin group than in the normal weight group (adjusted odds ratio (aOR) = 1.77; 95% confidence interval (CI) = 1.34–2.33) and lower in the overweight/obese group (aOR = 0.64; 95% CI = 0.51–0.80). Additionally, those in metropolitan and small–medium sized cities had a proteinuria prevalence about 1.5-fold higher than that of those in rural areas (95% CI = 1.08–2.02, 95% CI = 1.19–1.92, respectively). Proteinuria was associated with environmental pollution, including smoking rate, ambient particulate matter and heavy metals in drinking water (aOR = 1.10; 95% CI = 1.01–1.20; aOR = 1.06; 95% CI = 1.01–1.11, aOR = 1.001; 95% CI = 1.0001–1.0015). These results suggest that to improve health management effectiveness, kidney disease prevention efforts for children and adolescents should focus on geographical area and environmental pollution, as well as body weight as individual factors.

Epidemiology of IgA Nephropathy: A Global Perspective

IgA nephropathy (IgAN), or Berger's disease, is the most common primary glomerular disease worldwide, but varies largely in its geographic distribution. A systematic review of 1,619 publications from the five continental regions of the world was performed to assess the prevalence of IgAN in different worldwide regions and analyze factors responsible for geographic differences. All observational studies that described the prevalence and incidence data on glomerulonephritis were considered. IgAN is more frequent in Asian populations (45 cases per million population/y in Japan) than in Caucasians (31 cases per million population/y in France). These differences are owing to some relevant aspects: (1) systematic mass screening of urine in populations, as occurring in some Asian countries (Hong Kong, Japan, Korea, and Singapore), is not common in Western countries; (2) general practitioners and health care professionals in Western countries underestimate persistent microscopic hematuria and/or mild proteinuria in apparently healthy individuals causing late referral to a nephrologist; and (3) nephrologists adopt different indications for kidney biopsy in individuals with persistent urinary abnormalities. In addition, differences also are owing to the source of data, because the frequency of IgAN observed in a nephrology center with a high incidence of kidney biopsies is higher than in a regional renal biopsy registry that receives data from many centers. In conclusion, greater efforts should be made to diagnose IgAN earlier in individuals who manifest persistent microhematuria and/or mild proteinuria and to introduce less stringent indications for kidney biopsies. This preventive approach, followed by early therapy, may reduce the global burden of end-stage kidney disease caused by IgAN.

Urinary Screening for Early Detection of Kidney Diseases

OBJECTIVE

Urinary screening is a simple inexpensive tool to evaluate kidney functions. The authors carried out urinary screening of school children for early detection of kidney diseases.

METHODS

Children in the age group 5-15 y were screened for urinalysis. They were divided in 2 groups; group-1 included 5-10 y and group-2 included >10-15 y old children.

RESULTS

Urine samples of 3340(78%) out of 4283 enrolled children were tested. Abnormal samples were found in 5.75%; with proteinuria in 4.59%, pyuria in 3.29% and hematuria in 4.31%. Males constituted 47.71% in group-1 and 54.64% in group-2. Low body mass index was found in 94.1% group-1 and 78.99% group-2 children. Mild proteinuria was found in 1.2% group-1 and 2.56% group-2 children. Severe proteinuria was more in group-2 (0.77% vs. 0.06%) with female preponderance. Glucosuria was found in 1 boy of group-2. Urobilinogen was more in group-2 (0.65% vs. 0.24%) with male preponderance. Nitrituria was found in 9 girls. Pyuria (2.02% vs. 1.27%) and hematuria were more in group-2 (3.04% vs. 1.87%) with female preponderance. Combined proteinuria and hematuria (0.42% vs. 0.24%) as well bacteruria and fungaluria were more in group-2 (4.11% vs. 1.39%). Six of 192 children with abnormal urinary findings were treated; 1 for urinary calculus and 5 for urinary tract infection.

CONCLUSIONS

Abnormal urinary findings were more common in children >10 y of age. Thus urinary screening program of children can become useful for early detection of kidney diseases and contribute towards building up of a healthy nation.

The First Report on the Frequency of Asymptomatic Proteinuria in Iranian School-aged Children

Background

Proteinuria is a well-known indicator of renal dysfunction. In this study, we evaluated the frequency of proteinuria in a sample of healthy Iranian elementary school students using both dipsticks and urine albumin-to-creatinine ratio (UACR) methods.

Materials and Methods

This cross-sectional study was performed on 478 school students aged 7-9 years who were selected by multistage random cluster sampling from Isfahan city, Iran. A clean midstream first-morning urine sample was obtained from each subject. Urine samples were examined by dipstick method, and accordingly, they were reported as negative; trace; 1+; 2+; 3+; and 4+. UACR was determined in samples with positive dipstick proteinuria (defined as trace or greater).

Results

This study included 478 students (42.8% boys), with mean age of 7.0 ± 0.4 years. Positive dipstick was detected in 124 (25.9%) cases. The frequency of positive dipstick proteinuria was significantly higher in the girls than boys (29.6% vs. 20.9%, respectively; P = 0.04). In cases with a positive dipstick, 10 (2.1%) cases had UACR 30-300 mg/g. The frequency of UACR of 30-300 mg/g was 1.4% and 2.5% in boys and girls, respectively. There was no significant difference in the frequency of UACR 30-300 mg/g in terms of gender (P = 0.4). None of the subjects had UACR above 300 mg/g.

Conclusion

While the frequency of asymptomatic proteinuria varies widely across different studies, we found a higher rate of proteinuria in Iranian children. Cost-effectiveness analyses are needed to justify large screening program for detecting asymptomatic proteinuria, as a cardinal manifestation of kidney disease, in Iranian children.

A large retrospective review of persistent proteinuria in children

BACKGROUND

Proteinuria is a common finding in children. It may be due to a benign cause, but it can also represent early renal injury. Of children with persistent proteinuria noted in mass urine screening programs, 35% have a urine protein level greater than 100 mg/dl and many of them are associated with many underlying renal diseases. The aim of this study was to identify the etiology and prognosis of persistent proteinuria in children.

METHODS

We collected data on urine protein from January 2011 to December 2016 in a tertiary medical center. During this 6-year period, 37,645 children received urinalysis, and 2.3% were found to have persistent proteinuria. We reviewed their medical charts for clinical diagnoses and renal function. According to the level of persistent proteinuria, we divided the children into three groups (mild, moderate, and severe).

RESULTS

Most clinical diagnoses in the mild persistent proteinuria group were not readily identifiable. In the moderate and severe groups, acute kidney injury was the leading cause of significant proteinuria, followed by systemic lupus erythematosus, steroid-sensitive nephrotic syndrome, and congenital urogenital tract anomalies. There were significant differences in the rate of chronic renal insufficiency among the three groups. Prematurity with extremely low birth weight was also a major factor associated with pediatric chronic renal insufficiency.

CONCLUSION

Assessing persistent proteinuria in children is important due to the diverse range of associated diseases or mortality.

A Cross-sectional Prospective Study of Asymptomatic Urinary Abnormalities, Blood Pressure, and Body Mass Index in Healthy School Children

Introduction

Screening school children for urinary abnormalities is an inexpensive task but is not commonly undertaken in India. Although debated in western countries, its utility in early diagnosis of kidney disorders has been proved by studies from Asia. We examined the prevalence of asymptomatic urinary abnormalities (AUA), obesity, and hypertension in school children and analyzed data to identify potential risk factors among those detected with such abnormalities.

Methods

Children and adolescents 8 to 18 years of age of either gender, attending 14 public schools in West Bengal, were screened prospectively from July 2013 to July 2016 for detecting asymptomatic urinary abnormalities by a spot urine test using a dipstick. Sociodemographic profile, medical examination (weight, height, and blood pressure), and questionnaire-based data were recorded.

Results

A total of 11,000 children were screened. Of these, data from 9306 children were available for AUA, obesity, and hypertension. The prevalence rate was 7.44% (95% confidence interval [CI] = 6.91%−7.97%) for at least 1 AUA. Isolated hematuria was present in 5.2% (95% CI 4.75%−5.65%), whereas isolated proteinuria was present in 1.9% (95% CI = 1.62%−2.18%). The prevalence of prehypertension was 13.43% (95% CI = 12.74%−14.12%) and that of hypertension and abnormal body mass index was 4.05% (95% CI = 6.43%−7.47%) and 38.67 (95% CI = 37.68%−39.66%) respectively.

Discussion

The prevalence rates of AUA were comparable with those in some Asian countries but higher than in most developed countries. Of children and adolescents 8 to 18 years of age, those 13 to 18 years had significantly more high risk factors such as AUA, hypertension, and obesity.

Prevalence of hypertension, obesity, hematuria and proteinuria amongst healthy adolescents living in Western Saudi Arabia

Objectives:

To determine the prevalence of hypertension, obesity, hematuria, and proteinuria among healthy adolescents and to determine the associated risk factors.

Methods:

This is a cross-sectional study of 8 intermediate schools in Jeddah, Saudi Arabia between March 2015 and June 2015. Samples were selected randomly and equal proportions from each school for both genders were ensured. Both blood pressure and body mass index were measured and a brief questionnaire was filled out for the specified studied group. Urine dipstick analysis was carried out for 294 children. A second questionnaire was completed for hypertensive and obese subjects in addition to those with hematuria and proteinuria.

Results:

A total of 401 children (200 males) with a mean (SD) age of 13.87 (1.27) were included. Hypertension was found in 17.2% with a male to female ratio of 1.4:1. Pre-hypertension was found in 4.2% of our sample with a male to female ratio of 2.1:1. Obesity was found in 19.2% with a male to female ratio of 1.5:1. Obesity was found to be the most significant risk factor for hypertension with a related risk: 2.87, 95% and confidence interval: 1.9-4.3. For urine abnormalities, 10.2% of samples were positive for proteinuria, 17% for hematuria, and 3.1% for both.

Conclusion:

It was found that there is a positive correlation between the incidence of obesity and hypertension in adolescents. Hematuria and proteinuria were also found to be high. Screening and prevention programs are therefore recommended.

The Transition from Thin Basement Membranes to Typical Alport Syndrome Morphology in Children

Some children with thin basement membranes (TBM) turn out to have Alport syndrome (AS). In our population of 58 children initially diagnosed with TBM, three were eventually diagnosed with AS. As a group, these three were first biopsied at a younger age, and had gross rather than microscopic hematuria. Only one had lamellations initially. Seven others had some degree of basement membrane lamellations at initial biopsy, but none of these have developed other features of AS. We concluded that at least 5% of children initially demonstrating TBM go on to manifest the classical electron-microscopic findings of AS during childhood. Episodes of gross hematuria with TBM can be a significant clue of AS. Genetic and/or immunofluorescent studies for type IV collagen, and continued long-term follow-up should be done in all children with TBM.

Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m(2)

BACKGROUND

The chronic kidney disease (CKD) classification system for children is similar to that for adults, with both mainly based on estimated glomerular filtration rate (eGFR) combined with fixed cut-off values. The main cut-off eGFR value used to define CKD is 60 mL/min/1.73 m(2), a value that is also applied for children older than 2 years of age, adolescents and young adults.

METHODS

Based on a literature search, we evaluated inclusion criteria for eGFR in clinical trials or research studies on CKD for children. We also collected information on direct measurements of GFR (mGFR) in children and adolescents, with the aim to estimate the normal reference range for GFR. Using serum creatinine (Scr) normal reference values and Scr-based eGFR-equations, we also evaluated the correspondence between Scr normal reference values and (e)GFR normal reference values.

RESULTS

Based on our literature search, the inclusion of children in published CKD studies has been based on cut-off values for eGFR of >60 mL/min/1.73 m(2). The lower reference limits for mGFR far exceed this adult threshold. Using eGFR values calculated using Scr-based formulas, we found that abnormal Scr levels in children already correspond to eGFR values that are below a cut-off of 75 mL/min/1.73 m(2).

CONCLUSIONS

Abnormal GFR in children, adolescents and young adults starts below 75 mL/min/1.73 m(2), and as abnormality is a sign of disease, we recommend referring children, adolescents and young adults with an (e)GFR of <75 mL/min/1.73 m(2) for further clinical assessment.

An analysis of long-term occurrence of renal complications following pediatric pyeloplasty

OBJECTIVE

Few reports discuss post-pubertal renal complications after pyeloplasty. We analyzed long-term complications, such as decreased renal function (RF) measured by serum creatinine (SCr), hypertension (HTN), or proteinuria (protU) following pediatric pyeloplasty.

SUBJECTS AND METHODS

We retrospectively investigated 257 patients who underwent dismembered pyeloplasty due to ureteropelvic junction obstruction from January 1986 to December 2001. Medical history, preoperative and postoperative blood pressure, urinalysis, and SCr results were reviewed.

RESULTS

Fifty-five patients (47 male, 8 female) who were followed up for at least 10 years with post-pubertal follow-up data available were analyzed. Seven (12.7%) patients were diagnosed with HTN, and 10 (18.2%) with protU. The grade of hydronephrosis decreased, and the differential RF measured by MAG-3 renal scan significantly increased at final analysis (p<0.001). Presence of preoperative symptoms (p=0.034), and SCr elevation (p=0.018) showed correlation with HTN. HTN took 15.7 (±5.8) (7-25) years, and protU detection took 16.2 (±5.9) (6-23) years, with the highest incidence of both HTN and protU between 15 and 20 years postoperatively.

CONCLUSION

According to our investigation, a prudent evaluation of signs of RF decrease at 10 years after surgery, and then every 5 years, until 20 years should be recommended, although further studies are necessary.

Incidence and renal survival of ESRD in the young Taiwanese population

BACKGROUND AND OBJECTIVES

ESRD in the young represents a heavy burden to patients, families, and health care systems. This nationwide retrospective study characterized the incidence of ESRD and analyzed diagnoses associated with renal survival in the young population in Taiwan.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Through use of Taiwan's National Health Insurance Research Database, the population of young patients (age<30 years, including children and young adults) with ESRD between January 1998 and December 2009 were enrolled. The medical claims were used to derive the date when the cause of ESRD was first determined. The medical data were reviewed and the renal survival time (time from first diagnosis of the cause to the start of ESRD) was calculated by experts, including clinical physicians and a large-database specialist.

RESULTS

The incidence rate of ESRD in the young population was high compared with the worldwide rate at 21.1 per million person-years, whereas the incidence in the pediatric group was still similar to that in other countries at 10.3 per million person-years. A total of 2304 patients with new-onset ESRD and identified renal diseases during the study period were enrolled. All preschool-age patients (100%) began receiving peritoneal dialysis as their initial treatment for ESRD. The leading causes, which varied by sex and onset age, were glomerulonephropathy followed by hypertension for the young adult group and glomerulonephropathy followed by congenital anomalies of the kidney and urinary tract (CAKUT) for the pediatric group. Renal survival was cause-dependent. The median overall renal survival duration was 0.8 year (interquartile range [IQR], 0.7-3.5 years). CAKUT-related ESRD had the longest progression time (median renal survival, 16.0 years; IQR, 10.7-23.5 years); glomerulonephropathy progressed more rapidly into ESRD and had the shortest median renal survival of 0.5 year (IQR, 0.1-2.7 years).

CONCLUSIONS

The incidence and causes of ESRD greatly differ between pediatric patients and young adults. Moreover, renal survival in the young population markedly varies depending on the cause of renal disease.

Epidemiological urinalysis of children from kindergartens of Can Gio, Ho Chi Minh City - Vietnam

Background

Recent studies on Vietnamese children have shown that kidney diseases are not detected early enough to prevent chronic renal failure. The dipstick test is a simple and useful tool for detecting urinary abnormalities, especially in isolated or remote areas of Vietnam, where children have limited access to health care.

Methods

This cross-sectional study was conducted in 2011 at seven kindergartens in Can Gio district, Ho Chi Minh City, Vietnam. Two thousand and twelve children, aged 3 to 5, were enrolled. Morning mid-stream urine samples were examined by dipstick. Children with abnormal findings were re-examined with a second dipstick and underwent further investigations.

Results

Urinalysis was available for 1,032 boys and 980 girls. Mean age was 4.4 ± 0.8 years. Urinary abnormalities were detected in 108 (5.5%) of the subjects. Among them, nitrituria and leucocyturia accounted for more than 50%. Positive fractions of proteinuria, hematuria, nitrituria, leucocyturia, and combined nitrituria and leucocyturia after two dipsticks were 0.1%, 0.1%, 2%, 1% and 0.3%, respectively. Abnormal findings were more common in girls than boys (p < 0.001), and higher in communes with very low (< 50 persons/km²) population density (14.3% vs 4.1%, p < 0.001). A renal ultrasound detected four cases of hydronephrosis and one case of duplication of ureter.

Conclusions

The prevalence of urinary abnormalities in asymptomatic children in South Vietnam demonstrates the need for hygiene education among parents. Training for dipstick usage for all medical staff at health stations, especially in remote areas and in places with very low population density, is also clearly necessary. Routine urinalysis can be set up if a close control is conducted at locations.

Dipstick urine analysis screening among asymptomatic school children

Background:

Mass urinary screening is a useful tool to identify children with asymptomatic progressive renal diseases. A dipstick urinalysis screening was conducted to detect such prevalence and to set up a more effective screening program for children.

Patients and Methods:

A cross sectional study was carried out in seven nurseries and primary schools in different regions of Lebanon (Beirut, North Lebanon, and Valley of Bekaa) between February 2010 and March 2010. Eight hundred seventy asymptomatic children were enrolled in this study. First morning mid steam urine samples were obtained from students and were tested by dipstick method. Children with abnormal findings were re-tested after fifteen days.

Results:

Twenty five (2.9%) children had urinary abnormalities at the first screening; Eighteen (72%) of them still had abnormal results at the second screening. Among all the students, hematuria was the most common abnormality found with a prevalence of 1.5%, followed by nitrituria (0.45%), combined hematuria and nitrituria (0.45%) and proteinuria (0.1%). Urinary abnormalities were more common in females than in males. With respect to age, most positive results were detected at 6 years of age. Hematuria and proteinuria were mainly present in the North of Lebanon.

Conclusion:

Asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding and to determine whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who develop end-stage renal disease.

Epidemiology of chronic kidney disease in children

In the past 30 years there have been major improvements in the care of children with chronic kidney disease (CKD). However, most of the available epidemiological data stem from end-stage renal disease (ESRD) registries and information on the earlier stages of pediatric CKD is still limited. The median reported incidence of renal replacement therapy (RRT) in children aged 0-19 years across the world in 2008 was 9 (range: 4-18) [corrected] per million of the age-related population). [corrected] The prevalence of RRT in 2008 ranged from 18 to 100 per million of the age-related population. Congenital disorders, including congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries, while acquired causes predominate in developing countries. Children with congenital disorders experience a slower progression of CKD than those with glomerulonephritis, resulting in a lower proportion of CAKUT in the ESRD population compared with less advanced stages of CKD. Most children with ESRD start on dialysis and then receive a transplant. While the survival rate of children with ERSD has improved, it remains about 30 times lower than that of healthy peers. Children now mainly die of cardiovascular causes and infection rather than from renal failure.

Recent and potential developments in the analysis of urine: a review

Analysis of urine is a widely used diagnostic tool that traditionally measured one or, at most, a few metabolites. However, the recognition of the need for a holistic approach to metabolism led to the application of metabolomics to urine for disease diagnostics. This review looks at various aspects of urinalysis including sampling and traditional approaches before reviewing recent developments using metabolomics. Spectrometric approaches are covered briefly since there are already a number of very good reviews on NMR spectroscopy and mass spectrometry and other spectrometries are not as highly developed in their applications to metabolomics. On the other hand, there has been a recent surge in chromatographic applications dedicated to characterising the human urinary metabolome. While developments in the analysis of urine encompassing both classical approaches of urinalysis and metabolomics are covered, it must be emphasized that these approaches are not orthogonal - they both have their uses and are complementary. Regardless, the need to normalise analytical data remains an important impediment.