Pugia M J, Murakami M, Lott J A, Ohta Y, Kitagawa T, Yamauchi K, Suhara Y, Kasjima J
Diagnostics Business Group, Bayer Corporation, Elkhart, IN, USA.
Clin Chem Lab Med. 2000 Oct;38(10):975-82. doi: 10.1515/CCLM.2000.145.
By governmental mandate, Japanese school children are screened annually for proteinuria, hematuria, and glucosuria to identify children with possible renal disorders. We added urine dipstick tests for albumin and creatinine to the Japanese screening protocol, and used their dipstick results for blood, glucose and protein. The sulfosalicylic acid precipitation test was used to confirm "trace" positive protein dipsticks. The Japanese and our screening protocol have in common the same data for glucosuria and proteinuria. Their scheme has an algorithm for repeat testing of children with abnormal results, and further testing and medical evaluation for those showing persistently abnormal values. Out of the 23,121 students, we found seven with likely nephritis, one with confirmed nephritis, one with nephrotic syndrome, 170 with persistent unexplained hematuria, 19 with persistent unexplained proteinuria, 14 cases of urinary tract infection, and 20 cases of likely diabetes mellitus. We conclude that dipstick testing for albumin, protein, creatinine, glucose and occult blood has significant value in a multilevel testing scheme for identifying children with urinary tract abnormalities or diabetes. The assay of albumin increases the sensitivity of the screening, and dividing the albumin by the creatinine concentration reduces the potential errors arising from concentrated or dilute urines.
根据政府规定，日本学童每年都要接受蛋白尿、血尿和糖尿筛查，以识别可能患有肾脏疾病的儿童。我们在日本的筛查方案中增加了尿试纸法检测白蛋白和肌酐，并将其试纸检测结果用于检测血液、葡萄糖和蛋白质。采用磺基水杨酸沉淀试验来确认尿试纸法检测蛋白质呈“微量”阳性的结果。日本的筛查方案和我们的筛查方案在糖尿和蛋白尿的数据方面是相同的。他们的方案有一个针对检测结果异常的儿童进行重复检测的算法，以及针对那些持续显示异常值的儿童进行进一步检测和医学评估的算法。在23121名学生中，我们发现7名可能患有肾炎，1名确诊为肾炎，1名患有肾病综合征，170名有持续不明原因血尿，19名有持续不明原因蛋白尿，14例尿路感染，以及20例可能患有糖尿病。我们得出结论，尿试纸法检测白蛋白、蛋白质、肌酐、葡萄糖和潜血在识别尿路异常或糖尿病儿童的多级检测方案中具有重要价值。白蛋白检测提高了筛查的敏感性，用白蛋白除以肌酐浓度可减少因尿液浓缩或稀释而产生的潜在误差。
