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Urinary screening and urinary abnormalities in 3-year-old children in Japan
Takeshi Yanagihara1, Riku Hamada2, Kenji Ishikura2
1Department of Pediatrics, Nippon Medical School.
Insights
Japanese preschool urinary screening identified high initial abnormality rates, but usefulness is uncertain. Proteinuria screening is important, while hematuria and asymptomatic UTI screening are inefficient.
Area of Science:
- Pediatrics
- Nephrology
- Public Health
Background:
- Japan has conducted mandatory preschool urinary screening since 1961.
- Systemic issues and uncertain utility prompted a review initiated in 2012.
- Analysis focused on abnormality frequency, associated diseases, clinical course, and UTI screening efficacy.
Purpose of the Study:
- To evaluate the effectiveness and identify limitations of Japan's preschool urinary screening program.
- To determine the diagnostic yield of screening for urinary abnormalities in young children.
- To assess the utility of screening for asymptomatic urinary tract infections (UTI) in detecting congenital anomalies.
Main Methods:
- Computerized literature search and review of Ministry of Health, Labour and Welfare study group reports.
- Analysis of urinary screening data from Akita City and Chiba City.
- Evaluation of urinalysis results, including frequency, disease identification, and clinical outcomes.
Main Results:
- Initial urinalysis showed high abnormality prevalence, decreasing significantly by the second test.
- Proteinuria indicated serious conditions, whereas isolated hematuria did not correlate with severe illness.
- Screening for asymptomatic UTI using urinary leukocytes proved inefficient; two consecutive urinalyses are recommended before further investigation.
Conclusions:
- The preschool urinary screening system requires revision due to low diagnostic yield and inefficiencies.
- Proteinuria is a key indicator for further investigation, while hematuria screening in 3-year-olds is not beneficial.
- Screening for asymptomatic UTI is ineffective for detecting congenital kidney and urinary tract anomalies.
Abstract:
In Japan, urinary screening for preschool children has been obligatory since 1961. The system was reconsidered and has been under review since 2012, because many problems in the system had been identified, and its usefulness was uncertain. In the process, the following were analyzed: (i) frequency of urinary abnormalities identified on screening; (ii) diseases identified from urinary abnormalities; (iii) clinical course of children found to have urinary abnormalities; and (iv) screening for asymptomatic urinary tract infection (UTI) as a way of screening for congenital anomalies of the kidney and urinary tract. A computerized literature search was conducted, and study reports issued by the Ministry of Health, Labour and Welfare study group, and data of Akita City and Chiba City were reviewed. The prevalence of abnormal results at the first urinalysis was high, but at the second urinalysis the prevalence decreased in the range 1/6-1/20. The prevalence of tentative diagnosis at the third urinalysis was similar to the school urinary screening results. Serious illness was not found in children who had hematuria alone. In contrast, diseases requiring immediate attention were found in children with proteinuria, although the prevalence of proteinuria was not high. The dipstick method for leukocyturia was inefficient. The importance of two consecutive urinalyses before detailed examination, the lack of usefulness of screening for hematuria in 3-year-old children, and the importance of proteinuria were confirmed. Screening for asymptomatic UTI using urinary leukocytes was very inefficient.
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