Abstract
Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan.Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined.Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students.Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.
Highlights
Chronic kidney disease (CKD) is currently a major global health problem
This study evaluated the longitudinal prevalence of hematuria and proteinuria and its association with different sociodemographic factors among school children in Hualien, Taiwan in two study periods
Older age, and habitation in suburban/rural areas were identified as risk factors for persistent hematuria
Summary
Chronic kidney disease (CKD) is currently a major global health problem. can CKD progress to end-stage renal disease (ESRD), it is a major risk factor for cardiovascular disease in later life [1]. In Taiwan, the annual incidence of pediatric ESRD was reported to be 8.12 cases per million of agematched population [2], with hematuria and proteinuria being the most common manifestations of pediatric CKD at diagnosis [3]. Aggressive treatment of patients with nephroticrange proteinuria and combined hematuria-proteinuria could delay CKD progression [4]. Asymptomatic glomerulonephritis (GN), manifesting as urinary abnormalities, can be detected via the school mass urinary screening (MUS) system, and MUS programs have been established for early detection of GN in Asian countries such as Japan, Korea, Singapore, and Taiwan, where GN is frequently the primary cause of ESRD [4,5,6,7]. Dipstick screening has been widely used as a simple and inexpensive method for detecting urinary abnormalities and has subsequently promoted public awareness of CKD [5, 7,8,9]
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