Abstract
We aimed to assess the utility of a newly developed automated urinary flow cytometer (UFCM) in differentiating the origin of hematuria in the mass screening system for renal diseases in school children. In total, 4,620 children aged 6–14 years with abnormal urinary findings by the screening program in Tokyo were enrolled. Tentative diagnoses were made based on the criteria for this screening program: nephritis in 11, suspected nephritis in 104, hematuria in 771, minimal hematuria in 1,506, proteinuria in 477, urinary tract infection in 83, and healthy in 1,668. Glomerular hematuria, assessed by UFCM, was found in 81.8% of nephritis, 58.7% of suspected nephritis, 59.7% of hematuria, 57.4% of minimal hematuria, 13.4% of proteinuria, and 21.5% of the healthy group. The presence of glomerular hematuria assessed by UFCM had a sensitivity of 61.0%, specificity of 78.5%, positive predictive value of 16.3%, and negative predictive value of 96.7% for the diagnosis of nephritis and suspected nephritis. Thus, our results imply that the absence of glomerular hematuria as assessed by UFCM is highly predictive of the absence of nephritis. If “healthy” children with non-glomerular hematuria by UFCM could be excluded, the total annual cost saving would be approximately 147.4 million JPY, which is equivalent to 5.2% of the current system. In conclusion, a simple, automated and rapid test for glomerular hematuria using UFCM is useful for mass screening. It can precisely predict children with only transient hematuria who do not have any serious illness, and therefore can exclude further unnecessary examinations, resulting in the improvement of cost-effectiveness of the current program.
Similar content being viewed by others
References
Kaneko K, Tsuchiya K, Kawamura R, Ohtomo Y, Shimizu T, Yamashiro Y, Yamada T, Yamauchi K, Kitagawa T (2002) Low prevalence of hypercalciuria in Japanese children. Nephron 91:439–443
Iitaka K, Ishidate T, Hojo M, Kuwao S, Kasai N, Sakai T (1995) Idiopathic membranoproliferative glomerulonephritis in Japanese children. Pediatr Nephrol 9:272–277
Yoshikawa N, Ito H, Sakai T, Takekoshi Y, Honda M, Awazu M, Ito K, Iitaka K, Koitabashi Y, Yamaoka K, Nakagawa K, Nakamura H, Matsuyama S, Seino Y, Takeda N, Hattori S, Ninomiya M (1999) A controlled trial of combined therapy for newly diagnosed severe childhood IgA nephropathy. The Japanese Pediatric IgA Nephropathy Treatment Study Group. J Am Soc Nephrol 10:101–109
Feld LG, Meyers KE, Kaplan BS, Stapleton FB (1998) Limited evaluation of microscopic hematuria in pediatrics. Pediatrics 102:E42
Birch DF, Fairley KF (1979) Haematuria: glomerular or nonglomerular? Lancet II:845–846
Fassett R, Hargan BA, Mathew TH (1982) Detection of glomerular bleeding by phase-contrast microscopy. Lancet I:1432–1434
Hauglustaine, Bollen W, Michielsen P (1982) Detection of glomerular bleeding using a simple staining method for light microscopy (letter). Lancet II:761
Hyodo T, Kumano K, Sakai T (1999) Differential diagnosis between glomerular and nonglomerular hematuria by automated urinary flow cytometer. Kitasato University Kidney Center criteria. Nephron 82:312–323
Murakami M, Yamamoto H, Ueda Y, Murakami K, Yamauchi K (1991) Urinary screening of elementary and junior high-school children over a 13-year period in Tokyo. Pediatr Nephrol 5:50–53
Carlson DA, Statland BE (1988) Automated urinalysis. Clin Lab Med 8:449–461
Acknowledgements
We are pleased to acknowledge the excellent language assistance of Dr. Mayako Hira, Department of Pediatrics, Juntendo University School of Medicine.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kaneko, K., Murakami, M., Shiraishi, K. et al. Usefulness of an automated urinary flow cytometer in mass screening for nephritis. Pediatr Nephrol 19, 499–502 (2004). https://doi.org/10.1007/s00467-004-1455-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-004-1455-7