Urinary screening and follow-up analysis of 6 615 school children in Chengdu city / 中华实用儿科临床杂志

Objective To investigate the prevalence of urine abnormalities for school children in Chengdu city and to evaluate the significance of urinary screening.Methods During January to December 2013,morning urine of 6 615 students were collected and screened by urine reagent paper.Two weeks later,the repeated screening was conducted in the children whose urine samples were positive for the first screening.Urine samples with positive testing results for twice were submitted to urine routine tests at local hospital,and the children with the urine positive results were defined as urine abnormalities.The children with urine abnormalities were transferred to a tertiary hospital and given treatment and follow-up.Results There were 6 615 cases receiving urine screening,including 2 624 cases (39.67 ％) of the grade I,and 3 991 cases(60.33％) at junior middle school.During the first screening,323 cases (4.83％) children had urinary occult blood positive,43 cases (0.65％) had urinary protein,20 cases (0.30％) had occult blood positive and proteinuria,and 103 cases (1.56％) had white cells in urine.During the second urine screening,62 cases (0.94％) had occult blood positive,6 cases (0.09％) had urinary protein,2 cases (0.03％) had proteinuria and occult blood positive,46 cases (0.70％) had white cells in urine.The incidence of urine abnormalities with occult blood positive,proteinuria,occult blood positive and proteinuria,and white cells in urine of children at junior middle school [1.38％ (55/3 991 cases),0.13％ (5/3 991 cases),0.05％ (2/3 991 cases),0.70％ (28/3 991 cases)] were significantly higher than those of children at primary school [0.27％ (7/2 624 cases),0.04％ (1/2 624 cases),0 (0/ 2 624 cases),0.69％ (18/2 624 cases)],and all the differences were statisticallysignificant (x2 =64.16,168.53,178.09,98.16,all P ＜ 0.05).In children transferred to a tertiary hospital for treatment,there were 4 cases with IgA nephropathy,1 case with minor glomerular abnormalities,and 12 cases with urinary tract infection.Conclusion Urinary screening is an effective way to find out kidney disease and urinary tract infection in children.Follow-ups should be strengthened.

A Case of Type II Membranoproliferative Glomerulonephritis Detected by School Urinary Screening Tests

Type II membranoproliferative glomerulonephritis (MPGN) is characterized by thickening of the glomerular basement membrane owing to electron-dense deposits on electron microscopy. We experienced a case of type II MPGN in a child presenting with proteinuria, hematuria on school urinary screening tests. He had been treated with losartan and enalapril. This is the first case report of type II MPGN detected by school urinary screening tests in Korea. Thus we report a case of 10-years-old male with type II MPGN with a review of brief literature.

Triagem urinária para erros inatos do metabolismo em crianças com atraso no desenvolvimento / Urinary screening for inborn errors of metabolism among children with delayed development

Objetivo: verificar a freqüência de positivos na triagem urinária para erros inatos do metabolismo, em crianças com atraso no desenvolvimento e correlacionar aspectos clínicos da população estudada com os resultados da triagem. Método: estudo transversal, descritivo, realizado no Programa de Estimulação Precoce da Unidade de Referência Materno-Infantil e Adolescente do Estado do Pará, em 197 crianças com atraso no desenvolvimento, através da realização de testes qualitativos de urina. Resultados: cerca de 52,8% dos pacientes apresentaram resultados positivos para, pelo menos, um teste. As crianças oriundas de outros municípios do Estado do Pará detiveram maior proporção de positivos, com p=0,003*. Dentre as manifestações clínicas investigadas, as convulsões e os problemas de alimentação destacaram-se pela freqüência. Conclusões: os resultados encontrados mostram a relevância da pesquisa de erros inatos do metabolismo em crianças com atraso no desenvolvimento. A triagem urinária ainda é um recurso laboratorial importante a ser utilizado, na investigação inicial de erros inatos.

Objectives: to investigate the frequency of positive urinary screening for inborn errors of metabolism among children with delayed development and to correlate clinical characteristics of the population studied with the screening results. Methods: this was a cross-sectional descriptive study, performed within the Early Stimulation Program of the Mother-Child and Adolescent Referral Unit of the State of Pará, on 197 children with delays development, by means of undertaking qualitative urine tests. Results: around 52.8% (104/197) of the patients presented positive results for at least one test. Children originating from other municipalities outside of Belém, the State Capital, had a higher proportion of positive tests, with p=0,003*. There was a higher proportion of positive tests when similar cases were reported in the family, or when there were stillbirths or deaths among siblings. Among the clinical manifestations investigated, convulsions and feeding problems had prominent frequencies. Conclusions: the results encountered show the relevance of research regarding inborn errors of metabolism among children with delayed development. Urinary screening is also an important laboratory tool for use in initial investigations.

The impact of early detection through school urinary screening tests of membranoproliferative glomerulonephritis type / 소아과

PURPOSE: Since 1998, school urinary screening tests have been performed on Korean school children. We could detect and treat so many asymptomatic chronic renal disease in early stage. We investigated the efficacy of school urinary screening tests from children with membranoproliferative glomerulonephritis (MPGN) type I. METHODS: We analyzed the characteristics and prognosis of 18 patients with MPGN type I who admitted after 1996 and received steroid therapy with or without cyclosporine. These patients were divided into two groups. Group A (asymptomatic patients detected by school urinary screening tests) consisted of 7 patients; Group S (symptomatic patients) consisted 11 patients. RESULTS: Mean follow-up duration was 6.3 years (from 2 to 11 years). Urinary protein excretion was 1.1 g/day in group A and 6.6 g/day in group S. 24 hour creatinine clearance (mL/min/1.73m2) was 134.3 in group A and 82.3 in group S. No patients in group A had renal insufficiency, but three patients in group S had renal insufficiency and one patient required peritoneal dialysis. CONCLUSION: Early detection by school urinary screening tests improves prognosis of MPGN type I.

A Clinical and Pathological Analysis of Children with Membranoproliferative Glomerulonephritis According to the Clinical Manifestations at Presentation

PURPOSE: Membranoproliferative glomeulonephritis(MPGN) has been diagnosed in an increasing number of asymptomatic cases. These cases have been detected by school urinary screening test even though the total cases of MPGN show a decreasing trend. We have analyzed the clinical and pathological characteristics of children with MPGN according to the clinical manifestations at the time of disease presentation. METHODS: A total of 18 patients who had been diagnosed with idiopathic MPGN by percutaneous renal biopsy from January 1990 to February 2004 were involved in our study. The patients were divided into 2 groups as the school urinary screening(A) group and the symptomatic(S) group according to the clinical manifestations at the time of disease presentation. RESULTS: Out of the total 18 patients, 8(44.4%) were in the S group and 10(55.6%) were in the A group. The mean serum total protein, albumin and C3 levels in the S group were significantly lower than those levels of the A group, respectively(4.9+/-1.2 g/dL vs 7.0+/-0.5 g/dL P=0.002, 2.8+/-0.9 g/dL vs. 4.1+/-0.3 g/dL P=0.002, 63.9+/-36.4 mg/dl vs. 100.8+/-39.5 g/dl P=0.041). The mean total protein amount of 24 hour collected urine in the S group were significantly higher than that of the A group(3684.0+/-2601.3 mg/m2 vs. 559.4+/-406.9 mg/m2, respectively, P=0.001). Hypocomplementemia was observed in 11(61.1%) out of 18 patients at the time of disease onset, 7(87.5%) in the S group and 4(40%) in the A group. However the hypocomplementemia was decreased in 6(33.3%) out of 18 patients at the time of final follow-up, 3(37.5%) in the S group and 3(30%) in the A group. According to the pathologic type, hypocomplementemia was observed 8 patients(61.5%) with type I disease, 1 patients (100%) with type II disease, 2 patients(50%) in type III disease at the disease onset, but 4 patients(30.8%) in type I disease, 1 patient(100%) in type II disease, 1 patient(33.3%) with type III disease at the time of last follow-up. The incidence of cellular crescent formation and tubular atropy, as observed on light microscopy, were higher in the S group compared to the A group. Mean grade of capillary wall thickening and, mesangial proliferation were significantly higher in the S group. CONCLUSION: MPGN, as diagnosed in patients with only asymptomatic urinary abnormalities, has been increasing, it is more frequent in asymptomatic patients than in patients with presenting symptoms. Our result suggests that MPGN should be considered in the renal biopsy diagnosis regardless of serum C3 level when urinary abnormalities are found by school urinary screening test.

Hematuria and Proteinuria in School Children

The following results were obtained through the screening survey to detect the prevalence of hematuria & proteinuria in the healthy Korean schoolchildren. A total of 2,888 primary schoolchildren in Seoul, examined to be healthy by the author were tested for hematuria and proteinuria during the period of 3 months from Apr. 1979 to June 1979. Hemacombistix of Ames Company, U.S.A. was used in this examination. 1. The prevalence of hematuria detected with Hema-combistix was 1.97%(57 children) and that of microscopic hematrua was 0.93% (27 children). The prevalence of proteinuria was noted in 2.04%(59 children). 2. The prevalence of hematuria detected with Hema-combistix was higher in female children as 2.66% among 1,355 children, compared to 1.37% among 1,533 male children, which was ore prominent in the age 9 year-old group. The prevalence in female was higher than in male in all but 7 year-old age group. 3. The prevalence of microscopic hematuria was higher in female children as 1.40% compared to 0.52% in male. The prevalence was higher in female children in all but 7 year-old age group. 4. The correlation of tests of hematuria between Hema-combistix and microscopcy showed 85.2% in sensitivity and 59.0% in specificity. And there showed a statistically significant difference in the prevalence rates detected as above one positive in the both tests. 5. The prevalence of proteinuria was higher in female children as 2.8%, compared to 1.37% in male, which was more prominent in the 11 year-old age group. The age prevalence of proteinuria showed increasing frequency as age increases. The highest age prevalence was 1.94% in 12 year-old age group among males and 4.91% in 11 year-old age group among females. 6. The prevalence of co-existence of microscopic hematuria and proteinuria was 0.07%, which was noted in 2 cases in each 8 year and 10 year-old group. 7. Microscopic hematuria was present mostly in the range of one positive(5-20 RBC/HPF), which was prominent in female children. However, hematuria detected as above three positive (above 40 RBC/HPF) was found in male children. 8. Proteinuria was noted mostly in the range of one positive(30mg/dl) and the prevalence of proteinuria above 100mg/dl was 9.52% in males & 13.16% in females. And proteinuria above 300 mg/dl was noted in one male child.