Urine Analysis as a Screening Tool in Early Detection of Renal Abnormalities in Asymptomatic School Children

Abstract

Background: Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Nellore, Andhra Pradesh, and to detect the prevalence of renal disorders using urine dipstick method and associated risk factors. Method: Out of total 1,626 children, 883 (54.31%) were male children and remaining 743 (45.69%) were female students. During the first screening by urine dipstick method, 45 (2.77%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Results: Finally 37 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.62%; isolated proteinuria (IP) was 0.18%; combined hematuria and proteinuria (CHP) was 0.18% and urinary tract infection (UTI) was 1.23%. Renal stone was the cause in 20% cases while post-infectious golmerulonephritis (PIGN) and IgA nephropathy (IgAN) were the causes of hematuria in 10% cases each. Out of three cases of CHP, two (66.67%) cases were due to PIGN and one was due to membranoproliferative glomerulonephritis (MPGN). Totally 26 cases were confirmed having UTI. Out of these 26 cases, gram-negative bacilli were detected in 11 (42.31%) cases and gram-positive were detected in five (19.23%) cases. The prevalence rate of renal abnormalities among 6 - 7 years, 8 - 9 years, 10 - 11 years and 12 - 13 years students was 2.07%, 2.43%, 2.19 and 2.41% respectively. Out of 889 urban students, 19 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic urban student was 2.14%. Out of 737 rural students, 18 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic rural student was 2.44%. Prevalence of hematuria in male was 0.23 and in female 1.08 and the difference was statistically significant (P < 0.05) which indicated hematuria more in female asymptomatic students compared to male asymptomatic students. Age wise prevalence of IP ranged from 0% in 6 - 7 years age group and 12 - 13 years age group to 0.44% in 10 - 11 years age group. Prevalence of UTIs in male was 0.57 and in female 2.02, and the difference was statistically significant (P < 0.05) indicating that the prevalence of UTIs was significantly more in female asymptomatic students compared to male asymptomatic students. Conclusions: In 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. World J Nephrol Urol. 2018;7(1):17-24 doi: https://doi.org/10.14740/wjnu325w