City-wide screening for urinary abnormalities in schoolgirls

Area of Science:

• Pediatrics
• Nephrology
• Infectious Diseases

Background:

• Urinary tract infections (UTIs) are common in children, potentially leading to long-term renal damage.
• Asymptomatic UTIs can be prevalent, complicating early diagnosis and intervention.
• Screening programs are crucial for identifying subclinical infections and associated renal pathologies in pediatric populations.

Purpose of the Study:

• To determine the incidence of UTIs in school-aged girls.
• To investigate the prevalence of renal scarring, chronic cystitis, and urethral stenosis in children with UTIs.
• To assess the occurrence of asymptomatic UTIs and associated findings like proteinuria and hematuria.

Main Methods:

• Screening of 23,427 schoolgirls aged 5-14 years for UTIs using Uricult.
• Hema-combistix used for detecting hematuria, glycosuria, and proteinuria.
• Confirmation of positive cultures by family physicians using standard techniques.
• Voiding cystogram utilized for reflux investigation in a subset of patients.

Main Results:

• Overall UTI incidence was 1.9%, with 58% of infected children being asymptomatic.
• Among infected children, 9.5% had pyelonephritic scarring, 58.7% chronic cystitis, and 58.7% urethral stenosis.
• Proteinuria incidence was 0.5% and hematuria incidence was 0.3%, with some cases showing pyelonephritic scarring without UTI.
• Four previously unrecognized cases of diabetes were detected.

Conclusions:

• A significant proportion of school-aged girls experience UTIs, often without prior symptoms.
• UTIs in this cohort are associated with a high prevalence of chronic cystitis, urethral stenosis, and pyelonephritic scarring.
• Screening programs can detect asymptomatic UTIs and related renal complications, alongside other conditions like diabetes.