A brief review of the recommendations for screening urinalysis in healthy asymptomatic children

1. To Pee Or Not To Pee
Screening Urinalysis in Healthy Children

2. Relevant Disclosure
Under Accreditation Council for Continuing Medical Education
guidelines disclosure must be made regarding relevant financial
relationships with commercial interests within the last 12 months.
Pascale H Lane, MD
I have no relevant financial relationships or affiliations with
commercial interests to disclose.

3. Learning Objectives
At the end of the presentation the audience should be able to:
1. List important characteristics of screening programs
2. State the current AAP recommendations for screening
urinalysis in otherwise healthy, asymptomatic children

4. Turn To Your Neighbors…
• Develop a consensus as a group regarding
when you would screen children with no
health issues or complaints with urinalysis
• You have 5 minutes…

5. Characteristics of Screening Programs
• Relatively simple tests with reproducible
results
• High level of sensitivity and specificity
• Effective treatment for the condition

6. Is UA Simple?
• Dipstick quite simple
• Collecting urine can be problematic

7. Is UA Reproducible?
Proteinuria
• Prevalence 6.3%
• 89% false + or transient
Hematuria
• Prevalence 1.6%
• 88% false + or transient
Much variation, especially for proteinuria, can be minimized by using first morning
voids.

8. Is UA Sensitive?
“Trace” is negative…

9. Is UA Specific?
• Something in the urine, but no indication of
cause or meaning.

10. Is There Effective Treatment?
• For some disorders, yes
• But little or no evidence that early detection
improves prognosis of most chronic kidney
diseases

11. National Mass School Screening
Urinalysis Programs
Year
Instituted
Country Frequency of
Screening
Specimen Follow-up
1974 Japan
Biannual 1974-79
Annual 1979-
present
Dipstick on
midstream first
morning specimen
Repeat UA in all
patients with
positive test
1990 Taiwan
Biannual 1990-
present
Dipstick on first
morning specimen
(Also BP
measurement)
Repeat UA 10-15
days after initial
positive test
1998 Korea
Annual 1998-
present
Dipstick on first
morning specimen
Repeat UA after
initial positive test
with microscopic
exam if both tests
positive
Clin J Am Soc Nephrol 4:509, 2009

12. What About US?

13. Pediatric End-Stage Kidney Disease
United States 2010-2012
Glomerulonephritis 23%
Secondary GN/Vasculitis 11%
Congenital 38%
Glomerulonephritis in Japan
1978-1980 69%
1999 35%
United States Renal Data System, 2014 Annual
Data Report: Epidemiology of Kidney Disease in the
United States. National Institutes of Health,
National Institute of Diabetes and Digestive and
Kidney Diseases, Bethesda, MD, 2014. Clin J Am Soc Nephrol 2:1360, 2007

14. American Academy of Pediatrics
(AAP) Recommendations Over Time
1977 – 1995 Infancy
Early childhood
Late childhood
Adolescence

15. Costs of Screening UAs for 2000
Children
Components Cost (Mid-1990s)
Initial screening dipstick
• 2000 dipsticks
• Urine bags for children <12m of age
$1290
Proteinuria Evaluation
• Second dipstick (126)
• For 13 patients with persistent
proteinuria:
First morning UA with micro
CBC; CMP
Referral to Nephrology
$1968-$2962
Hematuria Evaluation
• Second dipstick (32)
• For 4 patients with persistent
hematuria:
First morning UA with micro
CBC; CMP
Referral to Nephrology
$602-$908
Pediatrics 100:919, 1997

16. American Academy of Pediatrics
(AAP) Recommendations Over Time
1977 – 1995 Infancy
Early childhood
Late childhood
Adolescence
Of note, no urinalysis recommended for sports participation…
2007 – Present None
1995 – 2007 Preschool
Adolescence

17. What About Sports?
• Most children with chronic kidney disease will
benefit from physical activity
– In adults, sedentary lifestyle at initiation of dialysis
results in 62% greater risk for death
– Lowers blood pressure and helps maintain healthy
body weight
• Probably wise to limit exertion in patients with
severe hypertension until controlled

18. Objectives Revisited
List important characteristics of screening
programs
Relatively simple tests with reproducible
results
High level of sensitivity and specificity
Effective treatment for the condition
State the current AAP recommendations
for screening urinalysis in otherwise
healthy, asymptomatic children
None