Practicality of Screening Urinalyses in Asymptomatic Children in a Primary Care Setting

Abstract

The value of screening for proteinuria in the pediatric age group is a subject of current debate. Previous studies have1,2 reported proteinuria prevalence rates of 5.4% to 14.8% when random urine samples were tested. Since the test for proteinuria is simple and inexpensive, Bailey et al.3 recommended that indicator strip testing for proteinuria be done by the primary physician in preschool, preadolescent, and adolescent children. The Committee on Standards of Child Health Care4 suggests at least dipstick urinalyses as part of a regular health maintenance program. Haggerty5 recommends using only the dipstick tests for protein and glucose since these tests are simple and adequate. However, Bailey et al.3 and North6 do not recommend glucose screening since there is a low probability of finding new cases of diabetes mellitus. Dodge et al.7 are reluctant to recommend widespread screening in schoolchildren for proteinuria and hematuria because the significance of these two conditions is unknown in asymptomatic children. For those found to have proteinuria and/or hematuria, West8 proposes a systematic evaluation including determination of certain serum chemical values, radiographic studies, and even renal biopsy. To study the practicality of such a screening test in a primary care setting, we have reviewed 2,309 random dipstick urinalyses collected over a 26-month period. METHODS Indicator strip testing (Labstix) was performed on random urine samples of all eligible patients on their first visit for whatever reason to the pediatric clinic of West End Health Center, Houston. The center is one of a network of seven neighborhood clinics of the Harris County Hospital District and serves a low to moderate socioeconomic group.