EDITORIAL COMMENTARY Screening Urinalysis in Detection of Chronic Kidney Disease in Children Aditi Sinha 1 & Arvind Bagga 1 Received: 9 May 2018 /Accepted: 10 May 2018 # Dr. K C Chaudhuri Foundation 2018 In this issue of the Journal, Suthar et al. report results of urinalysis in 3340 children in a screening program in 17 government schools in Ahmedabad [1]. Urinalysis was ab- normal in 5.8% patients, most commonly due to isolated proteinuria or hematuria (2% each); hematuria with protein- uria was rare at 0.2%. As discussed by the authors, these findings are similar to those in reports of school screening programs across Asia [2–4]. While the authors report dif- ferences based on sex and age, the clinical significance of their findings is unclear. The authors report asymptomatic bacteriuria in approximately 3% children, which is not equivalent to urinary tract infection and has unclear rele- vance in the medium- or long-term [5]. Prospective screening studies emphasize that the diag- nosis of isolated microscopic hematuria should be made following 2–3 urinalysis, 1–2 wk apart. A number of con- ditions, including febrile illnesses, may result in transient microscopic hematuria and or proteinuria with satisfactory medium- and long-term outcomes. Findings based on one- time measurement, as in the present study, might therefore be an overestimate. It may have been rewarding to repeat urinalysis to confirm findings, collect information on co- morbidities (obesity, hypertension) and evaluate for the underlying cause. Two recent reports from Kolkata under- score the importance of complete evaluation to detect children with or at risk of chronic kidney disease (CKD). Urinalysis was coupled to measurement of blood pressure and body mass index (BMI) in 1176 and 11,000 children, aged 5–18 y [6, 7]. Multivariate logistic regres- sion found significant association between proteinuria and high blood pressure, low BMI and adolescence suggesting a role for targeted screening in these subgroups [ 7]. Proteinuria in school-based screening programs was previously linked to low or high BMI in two large studies from USA [8, 9]. Authors of the present manuscript mea- sured BMI but did not report it in the context of abnormal urinalysis of blood pressure. Regardless of concerns in study design, the present manuscript reopens debate on the utility of school screen- ing programs based around urinalysis [2]. This practice, presently universal in Japan, Korea and Taiwan, is pro- posed as a low cost intervention to detect CKD in children [3, 4]. Its proponents cite the decline in proportion of cases of end stage kidney disease (ESRD) caused by glomerulo- nephritis, from 69 to 34.5%, between 1980 and 2004 [3], decline in number of adolescents with end stage renal dis- ease (ESRD) from 174 in 1980 to 108 in 2002 [4], and lower rates of ESRD in Japanese than American adoles- cents [4], hypothesizing that early referral, biopsy and ad- equate therapy for glomerulonephritis may have caused these differences. However, the concomitant increase in proportion of cases contributed by diabetes and hyperten- sion due to changes in Japanese lifestyle suggests that a true decline in glomerulonephritis cannot be confirmed [2]. Further, urine dipstick is not cost-effective in screen- ing; one case of CKD was found per 800 children, at a cost of US$ 2780 per patient diagnosed [10]. The major- ity of patients with proteinuria detected through such testing only have orthostatic proteinuria [11]. These find- ings echo the experience in adult screening programs. Dipstick proteinuria was an inefficient tool, with poor sensitivity and high false positive rates, for detecting CKD in a population-based Korean study [12]. False pos- itive test results incur additional costs to families (travel, loss of wages) and healthcare systems (retesting and causal evaluation) and impact quality of life through patient/parental anxiety [13]. Data from a Japanese na- tionwide health examination program suggests that a con- siderable proportion of CKD is missed when only dip- stick proteinuria and not serum creatinine is used for screening [ 14 ]. Given the debatable utility, the American Association of Pediatrics no longer recom- mends a screening urinalysis for children [5, 15]. * Aditi Sinha aditisinhaaiims@gmail.com 1 Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India The Indian Journal of Pediatrics https://doi.org/10.1007/s12098-018-2707-z