Evelyn F. West

Proteinuria and hematuria in schoolchildren: Epidemiology and early natural history†

Over the past several decades screening for disease in large asymptomatic populations has increased, culminating most recently with a federal mandate for early, periodic screening, diagnosis and treatment of all children from low-income families. The present study of five consecutive examinations in over 12,000 schoolchildren shows the cumulative occurrence of proteinuria and hematuria to be surprisingly high (greater than 6%). Comparison of this large number of children with the few individuals in whom death occurs from chronic renal disease annually (less than 0.03%) suggests that the vast majority of these children with urinary abnormalities have either no renal disease or at most a self-limited condition. Observation of 512 children with proteinuria and 78 with hematuria for one to five years after initial detection and referral to their physician or clinic provides a measure of both contemporary management and early natural history. These observations suggest that there is a need to question the overall effectiveness of urinary screening and that early inclusion of roentgenographic and urologic investigations in management seems unwarranted. Rather, these children should be followed for long periods of time. Additional investigations are indicated when worsening of the abnormal findings or other evidence of renal or systemic disease occurs. If routine urinary screening is performed, it should be as one aspect of a multiphasic program by the primary physician so that it can be coupled with a clearly defined plan for follow-up and management of subjects with abnormal findings.

Clinical experience in prevention of candidiasis by nystatin in children with acute lymphocytic leukemia

for the prevention of renal oSteodystrophy. In addition, fluid intake was restricted (he was anephric) and an anticholinergic drug was prescribed, both of which probably contributed to the constipation. It is difficult to know which factor played .the major part in the eventual bowel obstruction, but it would seem reasonable to exert due caution when any patient requires chronic usage of aluminum hydroxide. Efforts to lessen constipation, such as liberal fluid intake, use of laxatives, and, if renal function is not compromised, alternate use of magnesium containing antacids may reduce the risk of a fecal impaction. An appropriate history for constipationshould be a part of the ongoing care of these patients while they are receiving antacid therapy.

Detection of bacteriuria in children

Summary Lack of a simple, inexpensive, yet accuratemethod for urine culture has prevented universal, routine office screening of girls and pregnant women for the presence of bacteriuria. The present study demonstrates a high degree of reliability for a miniature culture method (Testuria) when compared with the quantitative pour plate technique in the examination of 8,469 urine specimens. Widespread application of this screening technique will, with a minimum of expense and inconvenience, allow the majority of these females to be reliably assured that they do not have significant bacteriuria. Re-examination of the few patients in whom the single Testuria culture result is suspicious (i.e., 4 or more colonies) with a more definitive bacteriologic method is then required in order to detect those who have significant bacteriuria.

Significance of transientbacteriuria in screening programs for bacteriuria

I N 1960 Kunin and associates 1 reported the results of screening of school children for significant bacteriuria utilizing the concept of the quantitative bacterial colony count introduced by Marple 2 and extended by Kass? In subsequent years a large number of infants and children have been similarly screened. 4-8 With this has come concern about the interpretation of borderline counts, the significance of transient bacteriuria, and the possible needless treatment of otherwise healthy asymptomatic girls? The current report attempts to provide information on this point by comparison of routine annual urine culture results over 4 years for schoolgirls initially found to have persistent significant

Nocturnal Enuresis: Correlation with Bacteriuria, Proteinuria and Dysuria

Nocturnal enuresis has troubled parents and physicians at least since the 16th century. Theories as to its cause and cure have varied with the fad and fashion of the times and, until recent years, most studies have remarkable principally for sampling bias and lack of controls. Myths which have been recently discarded include those relating it to deep sleep, lack of early toilet training, spina bifida occulta, low intelligence or common behavior problems. The present investigations of renal disease in school children presented a unique opportunity to evaluate the role of abnormal urinary findings in enuretic children and their non-enuretic classmates as well as re-examination of its association with sex, ethnic group, socio-economic level, birth order and mothers level of education and martial status.The prevalence of current bed-wetting for 6- to 10-year-old children was noted to be 18% for girls and 24% for boys (p < 0.001); and to differ significantly by ethnic group for girls but not for boys; by socio-economic level and family size for boys but not for girls; and for both sexes by mothers education but not by the other demographic characteristics examined. For girls, prevalence of significant bacteriuria increased in association with both presence and frequency of current enuresis (p < 0.005) and past complaint of dysuria (p < 0.025). No significant difference for prevalence of proteinuria in boys or girls was noted when analyzed by current enuresis or past complaint of dysuria.