Prevalence of Symptomless Urinary Tract Disease in Birmingham Schoolchildren. I--Pyuria and Bacteriuria

Abstract

Summary: In a pilot project 2,122 schoolchildren were screened for symptomless urinary tract disease by the examination of midstream urine specimens. These were tested for albumin, blood, and glucose with Labstix commercial strips, together with microscopy for abnormal cellular excretion.One case of renal glycosuria was found but none of previously undiagnosed diabetes mellitus. Out of 1,096 boys, 11 (1%) had pyuria-a leucocyte count greater than 10/cu.mm.-but only four showed abnormal counts on retesting. None had urinary tract infection.Out of 1,026 girls, 96 (9.3%) had pyuria initially but 35 were normal on retesting. Of the remaining 61 girls, 59 attended the outpatients department for further investigation, and in 30 vulvitis appeared to be the sole cause.Ten were proved to have significant bacteriuria and six of them showed radiological abnormalities.It is suggested that careful long-term studies are needed to study the economics and the implications of screening on a national scale.

Renal scarring and vesicoureteric reflux.

“…Community screening programmes have been directed mainly at schoolgirls (Savage et al, 1973;Asscher et al, 1973;Edwards et al, 1975), and only small numbers of preschool children have been investigated (Davies et al, 1974;Boothman et al, 1974;Kunin et al, 1976). The study of Boothman et al (1974) suggests that bacteriuria is byno means rare in boys under 5 years, in contrast to older boys (Kunin et al, 1962;Meadow et al, 1969). Moreover, our findings, like those of MacGregor and Freeman (1975) and , show at least as many infant boys as girls with reflux severe enough to be potentially damaging.…”

Urinary Infection in Two Selected Neonatal Populations

“…Screening of infants routinely in the neonatal period does not seem to be rewarding in revealing those children who will eventually develop severe radiological pyelonephritic scarring with the attendant poor prognosis in adult life. It seems more important to screen older children for urinary tract infection in order to detect major renal radiological abnormalities (Kunin, Deutscher, and Paquin, 1964;Savage et al, 1969;Meadow, White and Johnson, 1969 …”

Pyelonephritis lenta. Consideration of childhood urinary infection as the forerunner of renal insufficiency in later life.

“…Thus, Meadow, White, and Johnston (1969) found 2 unsuspected cases of infected reflux by routine urine screening of 1026 apparently healthy schoolgirls, while Savage et al (1969) who tested 943 5-year-old schoolgirls for bacteriuria, detected by this means 8 with infected reflux, 3 of whom already had focal renal scarring on x-ray. In none of these children had the parents recognized that anything was wrong, and in later life these patients would have been unaware of having had a urinary infection in early childhood.…”