Prevalence and patterns of asymptomatic urinary abnormalities among school children: a prospective cross-sectional screening study.

Shreyas A C; Alkarani T Patil; Jacqueline A Shah; Ranjitha M; Sathvika Chandrashekara Reddy

doi:10.51168/sgv9xr14

Authors

Dr. Shreyas A. C Senior Resident, Hemato oncology, B.J Wadia Hospital, India Author
Dr. Alkarani T. Patil Professor and HOD, department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India Author
Dr. Jacqueline A. Shah Assistant Professor, department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore Author
Dr. Ranjitha M Assistant Professor, Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India Author
Dr. Sathvika Chandrashekara Reddy Assistant Professor, Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India Author

DOI:

https://doi.org/10.51168/sgv9xr14

Keywords:

asymptomatic urinary abnormalities, school children, urine dipstick, hematuria, proteinuria, pyuria, renal screening

Abstract

Background

Asymptomatic urinary abnormalities in children may represent transient changes or early manifestations of renal and urinary tract disease. School-based urine screening may facilitate early detection, but abnormal dipstick findings require confirmation because many resolve on repeat testing.

Methods

This prospective cross-sectional screening study included school children aged 5–15 years attending three government-aided schools in Bangalore, India. First-voided early-morning, midstream clean-catch urine samples were examined using multiparameter urine reagent strips. Children with an abnormal initial result underwent repeat urine-dipstick testing and blood-pressure measurement after 15 days. Children with persistent abnormalities were referred for further clinical and laboratory evaluation. Categorical variables were assessed using the chi-square test, with p<0.05 considered statistically significant.

Results

Of 2,000 children approached, 1,920 were included. The study population comprised 1,066 boys and 854 girls. Initial screening identified urinary abnormalities in 162 children (8.43%). Isolated proteinuria was the most frequent finding (61, 3.18%), followed by hematuria (54, 2.81%), pyuria (41, 2.14%), and combined hematuria and proteinuria (6, 0.31%). After repeat testing, 42 children (2.19%) remained positive; 25.9% of initially positive children therefore had persistent abnormalities. Ten children attended hospital follow-up, where urinary tract infection, Henoch–Schönlein purpura, ureteric calculus, and membranoproliferative glomerulonephritis were identified.

Conclusion

Urinary abnormalities were relatively common during initial school screening but declined substantially after repeat testing. Repeat urinalysis is therefore essential before extensive investigation.

Recommendation

School-based screening should incorporate properly collected first-morning urine, repeat testing of positive results, blood-pressure assessment, appropriate quantitative confirmation, and a reliable referral pathway for children with persistent abnormalities.

Author Biographies

Dr. Shreyas A. C, Senior Resident, Hemato oncology, B.J Wadia Hospital, India

is a Senior Resident in Hemato-Oncology at B.J. Wadia Hospital, India. His professional interests include clinical medicine and the evaluation and management of hematological and oncological disorders.
Dr. Alkarani T. Patil, Professor and HOD, department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India

is Professor and Head of the Department of Pediatrics at Indira Gandhi Institute of Child Health, Bengaluru, India. His professional work focuses on pediatric healthcare, clinical assessment and management of childhood disorders.
Dr. Jacqueline A. Shah, Assistant Professor, department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore

is an Assistant Professor in the Department of Pediatrics at Indira Gandhi Institute of Child Health, Bengaluru, India. Her professional interests include pediatric clinical care, child health assessment and pediatric research.
Dr. Ranjitha M, Assistant Professor, Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India

is an Assistant Professor in the Department of Pediatrics at Indira Gandhi Institute of Child Health, Bengaluru, India. Her professional work includes pediatric clinical care, assessment and academic research.
Dr. Sathvika Chandrashekara Reddy, Assistant Professor, Department of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore, India

is an Assistant Professor in the Department of Paediatrics at Indira Gandhi Institute of Child Health, Bengaluru, India. Her professional interests include pediatric healthcare, clinical assessment and academic research.

References

1. Viteri B, Reid-Adam J. Hematuria and proteinuria in children. Pediatrics in Review. 2018;39(12):573-587. doi:10.1542/pir.2017-0300.https://doi.org/10.1542/pir.2017-0300

2. Kallash M, Rheault MN. Approach to persistent microscopic hematuria in children. Kidney360. 2020;1(9):1014-1020. doi:10.34067/KID.0003222020.https://doi.org/10.34067/KID.0003222020

3. Chaudhury AR, Reddy TV, Divyaveer SS, Patil K, Bennikal M, Karmakar K, et al. A cross-sectional prospective study of asymptomatic urinary abnormalities, blood pressure, and body mass index in healthy school children. Kidney International Reports. 2017;2(6):1169-1175. doi:10.1016/j.ekir.2017.07.018.https://doi.org/10.1016/j.ekir.2017.07.018

4. Banerjee M, Roy D, Lingeswaran M, Tomo S, Mittal A, Varma PP. Urinary screening in asymptomatic Indian children: a cross-sectional epidemiological study. EJIFCC. 2022;33(3):242-251.

5. Parakh P, Bhatta NK, Mishra OP, Shrestha P, Budhathoki S, Majhi S, et al. Urinary screening for detection of renal abnormalities in asymptomatic school children. Nephrourology Monthly. 2012;4(3):551-555. doi:10.5812/numonthly.3528.

https://doi.org/10.5812/numonthly.3528

6. Hajar F, Taleb M, Aoun B, Shatila A. Dipstick urine analysis screening among asymptomatic school children. North American Journal of Medical Sciences. 2011;3(4):179-184. doi:10.4297/najms.2011.3179.

https://doi.org/10.4297/najms.2011.3179

7. Nawaz H, Butt N, Anees M, Babar K. Prevalence of urinary abnormalities in asymptomatic school-going children by dipstick method. Pakistan Journal of Medical Sciences. 2024;40(11):2480-2484. doi:10.12669/pjms.40.11.8878.

https://doi.org/10.12669/pjms.40.11.8878

8. Cho BS, Kim SD. School urinalysis screening in Korea. Nephrology. 2007;12(Suppl 3):S3-S7. doi:10.1111/j.1440-1797.2007.00873.x.

https://doi.org/10.1111/j.1440-1797.2007.00873.x

9. Cho BS, Hahn WH, Cheong HI, Lim I, Ko CW, Kim SY, et al. A nationwide study of mass urine screening tests on Korean school children and implications for chronic kidney disease management. Clinical and Experimental Nephrology. 2013;17(2):205-210. doi:10.1007/s10157-012-0672-9.https://doi.org/10.1007/s10157-012-0672-9

10. Hogg RJ. Screening for chronic kidney disease in children: a global controversy. Clinical Journal of the American Society of Nephrology. 2009;4(2):509-515. doi:10.2215/CJN.01210308.https://doi.org/10.2215/CJN.01210308

11. Okur M, Arslan S, Guven AS, Temel H, Bektas MS, Ustyol L. Determination of underlying causes in asymptomatic, early-stage renal diseases by dipstick test. Medical Glas. 2013;10(1):55-58.

12. Chen MC, Wang JH, Chu CH, Cheng CF. Differential prevalence of hematuria and proteinuria with socio-demographic factors among school children in Hualien, Taiwan. Pediatrics and Neonatology. 2018;59(4):360-367. doi:10.1016/j.pedneo.2017.11.011.https://doi.org/10.1016/j.pedneo.2017.11.011

13. Vehaskari VM, Rapola J. Isolated proteinuria: analysis of a school-age population. Journal of Pediatrics. 1982;101(5):661-668. doi:10.1016/S0022-3476(82)80287-4.https://doi.org/10.1016/S0022-3476(82)80287-4

14. Kamyab F, Gholami M, Shaghaghi F, Bidkhori M, Kamali Z. Urine analysis with dipstick test in asymptomatic 7-year-old children. Journal of Education and Health Promotion. 2020;9:3. doi:10.4103/jehp.jehp_46_19.

https://doi.org/10.4103/jehp.jehp_46_19

15. Shaikh N, Osio VA, Wessel CB, Jeong JH. Prevalence of asymptomatic bacteriuria in children: a meta-analysis. Journal of Pediatrics. 2020;217:110-117.e4. doi:10.1016/j.jpeds.2019.10.019.https://doi.org/10.1016/j.jpeds.2019.10.019

16. Vivante A, Afek A, Frenkel-Nir Y, Tzur D, Farfel A, Golan E, et al. Persistent asymptomatic isolated microscopic hematuria in Israeli adolescents and young adults and risk for end-stage renal disease. JAMA. 2011;306(7):729-736. doi:10.1001/jama.2011.1141.

https://doi.org/10.1001/jama.2011.1141

17. Kawasaki Y, Suzuki J, Nozawa R, Suzuki H. Efficacy of school urinary screening for membranoproliferative glomerulonephritis type 1. Archives of Disease in Childhood. 2002;86(1):21-25. doi:10.1136/adc.86.1.21.

https://doi.org/10.1136/adc.86.1.21

18. Murakami M, Hayakawa M, Yanagihara T, Hukunaga Y. Proteinuria screening for children. Kidney International Supplement. 2005;(94):S23-S27. doi:10.1111/j.1523-1755.2005.09406.x.https://doi.org/10.1111/j.1523-1755.2005.09406.x

19. Sekhar DL, Wang L, Hollenbeak CS, Widome MD, Paul IM. A cost-effectiveness analysis of screening urine dipsticks in well-child care. Pediatrics. 2010;125(4):660-663. doi:10.1542/peds.2009-1980.https://doi.org/10.1542/peds.2009-1980

20. Honda K, Akune Y, Goto R. Cost-effectiveness of school urinary screening for early detection of IgA nephropathy in Japan. JAMA Network Open. 2024;7(2):e2356412. doi:10.1001/jamanetworkopen.2023.56412.

https://doi.org/10.1001/jamanetworkopen.2023.56412