New Aspects of Renal Diseases-From Urine Checkup to Kidney Transplantation-1. Renal Screening Tests

Abstract

The increase in recent years in the number of dialysis patients in Japan is thought to be mainly a result of westernization of the diet and an increase in the number of patients with diabetic nephropathy and hypertensive nephrosclerosis due to the aging population. Early detection and early treatment of kidney diseases are important for reducing the rate of increase in the number of dialysis patients, but many patients with kidney disease, diabetes mellitus or hypertension do not undergo medical examinations until the end stage of renal failure because of the lack of subjective symptoms. Thus, renal screening tests are important to reduce the incidence of kidney disease, though follow-up is important as well as renal screening tests. In this paper, the present status of renal screening tests in Japan is decribed, and problems in follow-up of persons who have shown abnormalities in results of basic health examinations, in the situation regarding examinations at medical institutions and in renal screening tests in Utsunomiya City (1) are discussed. Significance and problems in renal screening testsRenal screening tests are considered to be important for early detection and early treatment of kidney diseases and thus for reducing the incidence and the rate of progression of chronic renal failure. However, there are many problems at present concerning renal screening in Japan. One problem is that the methods used for urinalysis differ and the levels of accuracy are not the same. This problem must be resolved. Moreover, although urinalysis is carried out regularly for children up to the age of 15 years, this is not the case for people over the age of 15 years, and many people over the age of 15 years who show abnormalities in the results of urinalysis do not undergo subsequent examinations. It has also been pointed out that there is a lack of consistency in guidelines for subsequent management of company workers who show abnormalities in the results of urinalysis performed as part of health examinations for company employees. Moreover, both the percentage of adults in Japan who undergo health examinations and the percentage of adults showing abnormalities in results of urinalysis who undergo further examinations are low. It has also been pointed out that there is no evidence of early detection of renal disease being useful for preventing the progression of disease. Another current problem is that the number of specialists in Japan is not sufficient to cope with referrals of all persons who show abnor-