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Lessons learned from the Japanese nephritis screening study
1Department of Pediatrics, School of Medicine, Nihon University, Tokyo, Japan.
Insights
Japan's 13-year school urine screening program successfully detected early-stage kidney diseases like IgA nephropathy. This early detection of asymptomatic renal disease aids in understanding disease epidemiology and facilitates timely management.
Area of Science:
- Nephrology
- Pediatric Medicine
- Public Health
Background:
- A long-standing urine screening program for school children in Japan has aimed for early detection of asymptomatic renal disease.
- Understanding the epidemiological impact of this nationwide screening on chronic glomerular diseases is crucial.
Purpose of the Study:
- To assess the contribution of a 13-year nationwide school urine screening program to understanding the epidemiology of chronic glomerular disease in Japan.
- To evaluate the detection rates of specific glomerulonephritis types through mass urine screening.
Main Methods:
- A multicenter survey of patients identified through the school urine screening program.
- Analysis of detection rates for IgA nephropathy, non-IgA mesangial proliferative glomerulonephritis, and membranous proliferative glomerulonephritis (MPGN).
Main Results:
- Mass urine screening detected 70-80% of IgA and non-IgA mesangial proliferative glomerulonephritis cases and 65-80% of MPGN cases.
- Severe glomerular lesions were more common in children with incidental proteinuria/hematuria and significant proteinuria.
- Mild glomerular changes were frequent in MPGN and mesangial proliferative nephritis detected via screening, often with minimal proteinuria.
Conclusions:
- The Japanese school urine screening program is effective in the early detection of various chronic glomerular diseases.
- Screening identifies patients with milder disease presentations, suggesting potential for early intervention and management.
- Early detection through screening may facilitate timely management of glomerular diseases, particularly when effective treatments are available.
Abstract:
A program of urine screening for asymptomatic hematuria and proteinuria in school children has been conducted since 1973 by the Ministry of Education in Japan with great success in the early detection of asymptomatic renal disease. In order to know whether this nationwide program during 13 years has contributed to understanding of the epidemiology of chronic glomerular disease in Japan, a multicenter survey of the patients was conducted. Between 70% and 80% of IgA and non-IgA mesangial proliferative glomerulonephritis and 65%-80% of membrano-proliferative glomerulonephritis (MPGN) were detected by mass urine screening at school. Severe glomerular lesions were more frequently observed in children with chance proteinuria and hematuria, as well as IgA and non-IgA mesangial proliferative glomerulonephritis with significant proteinuria. Mild glomerular change was more frequent in patients with MPGN, IgA and non-IgA mesangial proliferative nephritis with minimal proteinuria who were detected by our screening program, rather than those seen with some of the nephritic signs and symptoms at diagnosis. The above evidence suggests that a screening program may open the way for the early management of these diseases, especially where treatment is already established.