Plata R, Silva C, Yahuita J, Perez L, Schieppati A, Remuzzi G
Mario Negri per L'America Latina, Renal Diseases Project, Department of Nephrology and Diálisis Hospital Juan XXIII, La Paz, Bolivia.
Nephrol Dial Transplant. 1998 Dec;13(12):3034-6. doi: 10.1093/ndt/13.12.3034.
The prevalence and incidence of renal diseases in developing countries are not known. This lack of knowledge is an obstacle to the adoption of preventive measures which may be of great value in a social and economic environment where treatment options for end-stage renal failure are simply not available to the vast majority of the population. Urinalysis, a simple and inexpensive test, remains a cornerstone in the evaluation of the kidney and may also be easily employed in mass screening for renal abnormalities in a developing country.
An educational campaign on renal diseases was conducted in three selected areas of Bolivia. Urine samples were collected and sent to one of 21 participating clinical centers. Fresh urine specimens were screened using a dipstick for chemical analysis and by microscopic urinalysis after centrifugation. In those patients in whom urinary abnormalities were found, further investigations were carried out in order to define the diagnosis; these patients were enrolled in a 3-year follow-up program.
Apparently healthy subjects (n = 14,082) were referred to the First Clinical and Epidemiological Program of Renal Diseases from rural and metropolitan areas in Bolivia. Urinary abnormalities were detected in 4261 subjects at first screening. The most common form of urinary abnormality was hematuria, which was found in 2010 (47% of positively screened subjects). Other renal abnormalities were leukocyturia (41%) and proteinuria (11%). Confirmatory tests and further clinical studies were then carried out in 1019 people. On a second screening 35% of the subjects had no urinary abnormalities; in the remaining people the following diagnosis were made: asymptomatic urinary-tract infection (48.4%), isolated benign hematuria (43.9%), chronic renal failure (1.6%), renal tuberculosis (1.6%). Other diagnosis were: renal stones 1.3%, diabetic nephropathy 1% and polycystic kidney diseases 1.9%.
This study helped define for the first time the frequency of asymptomatic renal diseases in Bolivia. It shows that it is possible to screen a large population of patients at relatively low cost, providing the framework for further action that may help in the prevention and timely diagnosis of renal diseases.
发展中国家肾脏疾病的患病率和发病率尚不清楚。这种知识的匮乏阻碍了预防措施的采用，而在一个绝大多数人口根本无法获得终末期肾衰竭治疗选择的社会经济环境中，预防措施可能具有巨大价值。尿液分析是一种简单且廉价的检测方法，仍然是评估肾脏的基石，并且在发展中国家也可轻松用于大规模筛查肾脏异常情况。
在玻利维亚三个选定地区开展了一场关于肾脏疾病的宣传活动。收集尿液样本并送往21个参与的临床中心之一。使用试纸条对新鲜尿液标本进行化学分析筛查，并在离心后进行显微镜尿液分析。在那些发现尿液异常的患者中，进行了进一步检查以明确诊断；这些患者被纳入了一项为期3年的随访计划。
来自玻利维亚农村和城市地区的明显健康受试者（n = 14082）被转诊至首个肾脏疾病临床和流行病学项目。初次筛查时在4261名受试者中检测到尿液异常。最常见的尿液异常形式是血尿，在2010名受试者中发现（占阳性筛查受试者的47%）。其他肾脏异常为白细胞尿（41%）和蛋白尿（11%）。然后对1019人进行了确诊检查和进一步的临床研究。再次筛查时，35%的受试者无尿液异常；在其余受试者中做出了以下诊断：无症状尿路感染（48.4%）、孤立性良性血尿（43.9%）、慢性肾衰竭（1.6%）、肾结核（1.6%）。其他诊断包括：肾结石1.3%、糖尿病肾病1%和多囊肾病1.9%。
本研究首次帮助确定了玻利维亚无症状肾脏疾病的发生率。研究表明，以相对较低的成本对大量患者进行筛查是可行的，为可能有助于预防和及时诊断肾脏疾病的进一步行动提供了框架。
