Screening for CKD in Children

Abstract

This review addresses the relevance of urinary screening for chronic kidney disease (CKD) in children. Ambiguity about screening children exists because of the uncertainty as to whether early detection of renal disorders in childhood will lead to effective interventions and reduction in the number of individuals who subsequently progress to ESRD. A related concern is whether the adoption of urinary screening programs is cost effective. The most common method that is used for screening children for CKD involves the measurement of spot samples of urine for hematuria and or proteinuria. Although mass screening is now well established in Japan, Taiwan, and Korea, there appears to be movement away from mass screening to detect CKD in children and adolescents in North America and Europe. In December 2007, the American Academy of Pediatrics published their latest recommendations, in which no urinalyses were recommended at any age during childhood. The second issue addressed in this review is the reporting of estimated glomerular filtration rates (GFR) in children by clinical laboratories.

Persistent Asymptomatic Isolated Microscopic Hematuria in Israeli Adolescents and Young Adults and Risk for End-Stage Renal Disease

“…11 We conducted a nationwide, populationbased, retrospective cohort study to evaluate the risk of treated end-stage renal disease (ESRD) in adolescents and young adults with persistent asymptomatic isolated microscopic hematuria.…”

Age- and gender-specific incidence rates of renal replacement therapy in Japan: an international comparison

“…Although data available in the present study do not provide sufficient information regarding why Japan has such lower incidence rates of paediatric ESKD, there are several potential explanations. First, universal screening with the urine dip-stick test, which was introduced as an annual urinalysis screening programme for every school child since 1973 in Japan, may have been effective in preventing ESKD in children, whereas no global consensus exists on whether screening for CKD should be undertaken in children and adolescents and whether such screening is cost effective [28]. Although direct evidence is lacking, early referral and intervention for glomerulonephritis identified by the screening programme may have reduced the incidence of childhood ESKD in Japan [27].…”

Pediatric Nephrology

“…Although well established in Japan, Taiwan, and Korea, there appears to be movement away from mass screening to detect CKD in children and adolescents in North America and Europe. 6 A more complete knowledge of the etiology, pathogenesis, molecular genetics of renal dysgenesis, and treatment of renal disease is needed before more effective prevention is achieved.…”