Abstract
BackgroundAnnual urinary screening is conducted at municipal kindergartens, elementary schools, and junior high schools in Ikeda City, Osaka, Japan (Ikeda City School System), and the results are reviewed by a general physician, but standards for when to recommend specialist referral have not been clear.MethodsIn all children attending the Ikeda City School System in 2012, dipstick urinalysis of a first-morning urine specimen was recommended once or twice, and if a second urinalysis showed proteinuria (≥1+), the urinary protein/creatinine ratio was measured. If this showed ≥0.2 g/g of creatinine (g/gCr), it was recommended that the child be evaluated by a specialist at Ikeda City Hospital.ResultsUrinary screening was performed in about 20% (388) of kindergarten, about 90% (5363) of elementary school, and about 86% (2523) of junior high school children living in Ikeda City. Urine samples were obtained from 387, 5349, and 2476 children, respectively. The urinary protein/creatinine ratio was ≥0.2 g/gCr in 13 children, including 1 elementary and 12 junior high children. In these 13 children, chronic nephritic syndrome (CNS) was suspected in 6 junior high school children, and of these, this was a new finding in 5, and renal biopsy was indicated in 3. In Ikeda City, the prevalence of CNS in elementary school children was <0.03%, the prevalence of CNS in junior high school children was 0.29%, and a renal biopsy was indicated in 0.14%. By eliminating the costs associated with assessment of the results by the Ikeda Medical Association, and by directly contracting with the testing company, the expenses paid by Ikeda City for the system itself decreased from 2,508,619 yen to 966,157 yen.ConclusionsIncorporating the urinary protein/creatinine ratio into the school urinary screening system in the Ikeda City School System and clarifying standards for specialist referral has enabled restructuring of the system so that is efficient and its effectiveness can be assessed.
Highlights
Annual urinary screening is conducted at municipal kindergartens, elementary schools, and junior high schools in Ikeda City, Osaka, Japan (Ikeda City School System), and the results are reviewed by a general physician, but standards for when to recommend specialist referral have not been clear
The population of Ikeda City as of April 1, 2012 was 103,199. This included 938 4-year-old children, 917 children with an age corresponding to the first grade of elementary school, and 981 children with an age corresponding to the first grade of junior high school
Because children usually continue at the same school where they were first-year students until their graduation, among children living in Ikeda City, about 88% attend a municipal elementary school or a municipal junior high school in Ikeda City
Summary
Annual urinary screening is conducted at municipal kindergartens, elementary schools, and junior high schools in Ikeda City, Osaka, Japan (Ikeda City School System), and the results are reviewed by a general physician, but standards for when to recommend specialist referral have not been clear. Annual urinary screening has been conducted in the Ikeda City School System based on revisions in the Enforcement Ordinance and Enforcement Regulations of the School Health Law in 1973. The school urinary screening results are evaluated by general physicians who are members of the local medical association. The objective of the school urinary screening has recently been focused on the detection of chronic nephritic syndrome (CNS). Measurement of the urinary protein/creatinine ratio on secondary testing has been introduced, and a system for referral of all children with proteinuria, defined as a urinary protein/creatinine ratio ≥0.2 g/gCr, for consultation at Ikeda City Hospital, a core medical institution in the region, has been established. In addition to considering the efficiency of the system, the morbidity rate of CNS was estimated, and the costs of the screening system were considered
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