Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan.
Nomura Pediatric Clinic, Shiga, Japan.
Nephrology (Carlton). 2020 Aug;25(8):599-606. doi: 10.1111/nep.13710. Epub 2020 Mar 20.
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.
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.
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.
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.
本研究旨在调查日本学校尿液筛查（SUS）项目中从筛查阶段到进一步检查阶段的进展情况。
本研究为回顾性队列研究，对 2012 年至 2017 年期间在日本滋贺县进行的 SUS 项目进行分析，研究数据来源于 SUS 项目的主要文件——学校生活指导表，包括尿液分析、随访和诊断结果。
在 2012 年至 2017 年期间，共有 107 名（6-11 岁）和 215 名（12-14 岁）小学生和初中生首次在 SUS 项目中发现尿液异常。在这些尿液异常的学生中，分别有 4.2%的小学生和 1.8%的初中生首次被诊断为疑似肾小球肾炎。总体而言，分别有 5.9%（95%置信区间：4.1%，7.7%）和 23.6%（95%置信区间：21.3%，25.9%）的蛋白尿阳性小学生和初中生未进行进一步检查。学生是否进行进一步检查的概率不受当地医疗福利的影响。
在当前的 SUS 项目中，筛查通常不会导致进一步的检查，尤其是在初中生中。为了保持 SUS 项目的完整性并防止年轻学生的肾脏疾病进展，应努力查明进一步检查的障碍，以减少因异常尿液检查结果而未进行进一步检查的学生比例。
