Uptake of further investigations following universal urinary screening among elementary and junior high school students in Shiga Prefecture, Japan: A retrospective cohort study. Issue 8 (20th March 2020)

• Record Type: Journal Article
• Authors: Sakai, Tomoyuki; Nomura, Yasuyuki; Sawai, Toshihiro; Hamada, Riku; Gotoh, Yoshimitsu; Yamamoto, Kazuna; Ichioka, Satoko; Masuda, Toshiki; Maruo, Yoshihiro; Honda, Masataka
• Is Part Of: Nephrology. Volume 25:Issue 8(2020)
• Page Start: 599
• Page End: 606
• Publication Date: 2020-03-20
• Subjects: glomerulonephritis -- haematuria -- proteinuria -- school life instruction sheet -- urinary mass screening; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13710
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: This study aimed to investigate the current progression status from screening phase to further investigation phase in the Japanese school urine mass screening (SUS) project. Methods: This retrospective cohort study on the SUS project across the Shiga Prefecture during 2012 to 2017 analysed data from school life instruction sheets, which are principal documents in the SUS project, regarding urinalysis, attendance at follow‐up and diagnoses. Results: Between the years 2012 to 2017, a median of 107 out of 83 749 elementary school students (aged 6‐11 years) and 215 out of 42 870 junior high students (aged 12‐14 years) had urine abnormalities identified for the first time in the SUS project. Among those with urine abnormalities, a mean of 4.2% of elementary school and 1.8% of junior high school students, respectively, were diagnosed with suspected glomerulonephritis for the first time. Overall, 5.9% (95% confidence interval [CI] 4.1, 7.7) and 23.6% (95% CI 21.3, 25.9) of proteinuria‐positive elementary and junior high school students, respectively, did not undergo further investigations. The probability of a student undergoing further investigations was not affected by the local availability of medical care benefits. Conclusion: In the current SUS project, screening frequently does not lead to further investigation, especially among junior high school students. To maintain the integrity of the SUS project and to prevent the progression of renal disease in young students, efforts including elucidation of barriers to further investigations should be made to reduce the proportions of students not undergoing further investigations for abnormal urinalysis findings. SUMMARY AT A GLANCE: This study examines the results of a mass urine screening program for kidney disease in schools in Shiga Prefecture, Japan. Despite screening a huge population, comparatively few children went on to more detailed investigations, which calls for elucidation of barriers to further investigations for abnormal urinalysis.