Department of Pediatrics, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan.
Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan.
Clin Exp Nephrol. 2022 Dec;26(12):1208-1217. doi: 10.1007/s10157-022-02265-2. Epub 2022 Sep 3.
Urinary screening for 3-year-olds cannot adequately detect congenital anomalies of the kidney and urinary tract (CAKUT).
Urinary screening for 3-year-olds was investigated over 30 years. Dipsticks for proteinuria, hematuria, glycosuria, leukocyturia, and nitrite at first screening, and dipsticks, urinary sediments, and renal ultrasonography at second screening were performed. Screening results were evaluated.
The positive rates of proteinuria, hematuria, leukocyturia, and nitrite relative to 218,831 children at the first screening were 1.0%, 4.6%, 2.3%, and 0.88%, respectively. Thirty-seven glomerular disease, 122 CAKUT, and 5 urological disease cases were found. We detected 6 stage 3-4 chronic kidney disease (CKD) and 3 end-stage kidney disease cases, including 3 CAKUT, comprising 2 bilateral renal hypoplasia and 1 vesicoureteral reflux (VUR), and 6 glomerular diseases, comprising 4 focal segmental glomerulosclerosis and 2 Alport syndrome. The positive rates relative to 218,831 children and CKD detection rates for each tentative diagnosis of mild hematuria, severe hematuria, proteinuria and hematuria, proteinuria, and suspected urinary tract infection were 1.4% and 0.67%, 0.11% and 3.7%, 0.01% and 28.6%, 0.02% and 45.0%, and 0.08% and 9.7%, respectively. Among 14 VUR cases with significant bacteriuria, 13 were found by leukocyturia, 12 had grade ≥ IV VUR, and 10 had severe renal scars.
Nine stage 3-5 CKD cases comprising 3 CAKUT and 6 glomerular disease were found by urinary screening of 3-year-olds among 218,831 children. The combination of urine dipsticks including leukocyturia at the first screening and ultrasonography at the second screening appeared useful.
3 岁儿童的尿液筛查不能充分检测出先天性肾和尿路异常（CAKUT）。
对 3 岁儿童的尿液筛查进行了 30 多年的研究。在初次筛查时使用尿蛋白、血尿、糖尿、白细胞尿和亚硝酸盐的试条，在第二次筛查时使用试条、尿液沉淀物和肾脏超声检查。评估筛查结果。
初次筛查 218831 名儿童的蛋白尿、血尿、白细胞尿和亚硝酸盐的阳性率分别为 1.0%、4.6%、2.3%和 0.88%。发现 37 例肾小球疾病、122 例 CAKUT 和 5 例泌尿科疾病。我们检测到 6 例 3-4 期慢性肾脏病（CKD）和 3 例终末期肾脏病病例，包括 3 例 CAKUT，其中 2 例双侧肾发育不良，1 例输尿管反流（VUR），6 例肾小球疾病，包括 4 例局灶节段性肾小球硬化症和 2 例 Alport 综合征。轻度血尿、重度血尿、蛋白尿和血尿、蛋白尿和疑似尿路感染的初步诊断的阳性率分别为 1.4%和 0.67%、0.11%和 3.7%、0.01%和 28.6%、0.02%和 45.0%和 0.08%和 9.7%。在 14 例伴有明显菌尿的 VUR 病例中，白细胞尿发现 13 例，IV 级以上 VUR 发现 12 例，严重肾瘢痕发现 10 例。
在 218831 名儿童中，通过对 3 岁儿童进行尿液筛查，发现了 9 例 3-5 期 CKD 病例，其中包括 3 例 CAKUT 和 6 例肾小球疾病。初次筛查时使用包括白细胞尿在内的尿试条，第二次筛查时使用超声检查，这种组合似乎很有用。
