Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
22 (
3
); 235-236
doi:
10.4103/0971-4065.98807

Feasibility of screening for urinary abnormalities as a part of school health appraisal

Division of Pediatric Nephrology, Department of Pediatrics, St. John's Medical College, Bangalore, India
Division of Pediatric Nephrology, Department of Community Medicine, St. John's Medical College, Bangalore, India

Address for correspondence: Dr. Nivedita Kamath, Division of Pediatric Nephrology, Department of Pediatrics, St. John's Medical College, Bangalore- 560 034, India. E-mail: n_shenoy25@yahoo.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

Urinary abnormalities can be asymptomatic in children and identified only by screening tests.[1] Several South East Asian countries perform urine screening as a part of regular health evaluation for school children. This is an effective method for prevention and early detection of chronic kidney disease.[24] No study has been conducted in India on urine screening in school children. The objectives were to study the prevalence of asymptomatic proteinuria and hematuria in school children and assess the feasibility of screening urine as a part of annual school health appraisal. We conducted a cross-sectional study from October 2008 to June 2009 among school children aged 5-16 years from schools in the urban slums of Bangalore. After obtaining informed consent from parents and teachers, a mid-stream sample of urine was freshly collected in a sterile container and tested within 30 minutes for proteinuria and hematuria using URS-9 (Teco diagnostics) dipsticks. Proteinuria 1+ to 4+ (30->2000 mg/dl) and hematuria 1+ to 4+ (10-200 RBC/μl) were considered abnormal. Hematuria was confirmed by microscopic examination. The reevaluation of isolated microscopic hematuria is recommended weekly for 2 weeks to look for persistence of hematuria.[56] However, we were able to reevaluate only after 3 months.

A total of 1597 children were included in this study. The male to female ratio was 1:1. A total of 752 (47.27%) children were between 5 and 10 years of age and 845 (52.72%) were between 11 and 16 years.

The prevalence of urinary abnormalities on initial evaluation was 7.82% (95% CI 3.2, 9.4). Proteinuria and hematuria on the first evaluation were seen in 1.9% and 5.8%, respectively. There was a significantly higher prevalence of urinary abnormalities in older children (9.8%), compared to younger children (5.18%) (P<0.01). Only 54.5% of the children with urinary abnormalities were available for re-evaluation. The prevalence of urinary abnormalities reduced from 7.8% to 1.9%. Those children who had persistent urinary abnormalities were advised to come to the Pediatric Nephrology OPD for further evaluation.

The prevalence of proteinuria and hematuria in our study population is comparable with other studies where the prevalence of hematuria varies from 0.5-7.2%.[2479] The prevalence of urinary abnormalities was significantly higher in the older age group and this was in concordance with other studies.[489] Persistent urinary abnormalities were found in 1.98% of children. This may be falsely low as only 55% were reassessed. The reduction in the prevalence may be due to transient abnormalities.

The feasibility of screening was assessed. Urine samples were obtained in all children. However, repeat evaluation could be done only in 55%. Younger children needed assistance with urine collection. The dipsticks could be split vertically into two parts to reduce the cost. The cost of urine screening was Rs. 10 per child and the time taken for screening was 5 to 7 minutes per child. Hence, urine screening is a simple, noninvasive, inexpensive, and feasible test which can be incorporated into the school health appraisal process.

We concluded that urine screening is a simple and feasible method for diagnosis of urinary abnormalities in asymptomatic children which requires periodic re-evaluation.

The limitations of our study were that an early morning urine sample was not collected. Repeat evaluation was done only after a gap of 3 months. Only 55% of children with urinary abnormalities were available for repeat evaluation. Further evaluation for the etiology of proteinuria and hematuria could add significance to the screening of urinary abnormalities in these children.

References

  1. , . Screening for CKD in Children: A Global Controversy. Clin J Am Soc Nephrol. 2009;4:509-15.
    [Google Scholar]
  2. , , , , , . Urinary screening of elementary and junior high-school children over a 13-year period in Tokyo. Pediatr Nephrol. 1991;5:50-3.
    [Google Scholar]
  3. , , . School urinalysis screening in Korea. Nephrology (Carlton). 2007;12(Suppl 3):S3-7.
    [Google Scholar]
  4. , , , , , , . Efficacy of urine screening at school: Experience in Shanghai, China. Pediatr Nephrol. 2007;22:2073-9.
    [Google Scholar]
  5. , . Evaluation of hematuria in children. Urol Clin North Am. 2004;31:559-73. x. Review
    [Google Scholar]
  6. , , , , . Consensus statement on evaluation of hematuria. Indian Pediatr. 2006;43:965-73.
    [Google Scholar]
  7. , , , , , . Role of urinary screening in children in the prevention of chronic kidney disease. Ann Acad Med Singapore. 2005;34:3-7.
    [Google Scholar]
  8. , , , , , , . School urinalysis screening in Shanghai. World J Pediatr. 2006;2:195-8.
    [Google Scholar]
  9. , , , , , , . Proteinuria in South Asian children: Prevalence and determinants. Pediatr Nephrol. 2005;20:1458-65.
    [Google Scholar]

    Fulltext Views
    307

    PDF downloads
    352
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections