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The prevalence of heavy proteinuria and progression risk factors in children undergoing urinary screening
1Department of Pediatrics, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Insights
Mass urinary screenings identified proteinuria in students. Early detection and monitoring of risk factors like high cholesterol and low albumin can delay chronic renal insufficiency (CRI) progression and dialysis.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Public Health
Background:
- Proteinuria and chronic renal insufficiency (CRI) are significant health concerns in children.
- Early detection and intervention are crucial for managing renal disease progression.
Purpose of the Study:
- To evaluate the prevalence and incidence density of heavy proteinuria and CRI in students.
- To identify factors associated with disease progression to CRI.
Main Methods:
- Retrospective analysis of 10,288,620 urinary screenings from 1992-1996 in elementary and junior high-school students.
- Comprehensive blood and urine sample analyses were performed.
- Logistic regression analysis was used to identify risk factors for CRI progression.
Main Results:
- Higher prevalence of proteinuria in girls; higher incidence density of CRI progression in boys.
- Significant decrease in the absolute number of patients with heavy proteinuria and in the percentage of glomerulonephritis in children on dialysis.
- Key risk factors for CRI progression identified: persistent high serum cholesterol (>220 mg/dl), low albumin (<3.5 g/dl), low total protein (<6 g/dl), and high diastolic pressure (>90 mmHg).
Conclusions:
- Mass urinary screening enables early detection of heavy proteinuria in students.
- Monitoring identified risk factors and timely treatment can delay renal disease progression and dialysis initiation.
- Early intervention supports the growth and development of predialysis CRI patients.
Abstract:
To evaluate the prevalence and incidence density of heavy proteinuria and chronic renal insufficiency (CRI) and the factors related to disease progression, 10,288,620 urinary screenings of elementary and junior high-school students from 1992 to 1996 were studied retrospectively. Urinary screening included pH, protein, occult blood, and glucose measurements. Blood sample analysis included total protein, albumin, A/G ratio, blood urea nitrogen, creatinine (Cr), antistreptolysin O titer, C3, cholesterol, hepatitis B virus surface antigen, IgA, and fasting blood sugar. The results showed that the 4-year prevalence of proteinuria was higher in girls than in boys (6.87x10(-4) vs. 4.83x10(-4) respectively). There were 189 cases with disease progression into CRI among the 10,288,620 students screened and followed continuously, with the prevalence of disease progression into CRI higher in boys than in girls (2.24x10(-5) vs. 1.41x10(-5) respectively). Of the 119 cases (63%) presenting with CRI since the first urine screening and blood sampling, only 14 had serum Cr levels higher than 6.0 mg/dl. There were 1,289 patients (10.5%) with proteinuria in 1992 and 705 patients (7.1%) in 1996. The absolute number of patients with heavy proteinuria decreased. The percentage of underlying glomerulonephritis in children on dialysis also decreased from 63.2% in 1992 to 47.0% in 1996. Logistic regression analysis showed that a persistent serum cholesterol level higher than 220 mg/dl, an albumin level lower than 3.5 g/dl, total protein less than 6 g/dl, and diastolic pressure higher than 90 mmHg were the significant risk factors for disease progression to CRI. We conclude that early detection of students with heavy proteinuria by mass urinary screening, early appropriate treatment, and monitoring of significant risk factors may help to decrease or delay the progression of renal disease, delay the introduction of dialysis in these predialysis CRI patients and maintain their growth and development.