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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA - AFRICA  
Year : 2016  |  Volume : 27  |  Issue : 5  |  Page : 1006-1010
Prevalence of proteinuria in school children (aged 12-14 years) in Kashmir valley, India, using dipstick method


1 Department of Nephrology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
2 Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
3 Department of Cardiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

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Date of Web Publication22-Sep-2016
 

   Abstract 

Screening for kidney diseases by urinalysis in school children is being conducted in many parts of the world with inexpensive tools such as urinary dipsticks. We conducted this study to know the prevalence of asymptomatic proteinuria in school children (age group 12-14 years) in Kashmir valley as no previous study is available. After applying exclusion criteria, 2068 children were screened for proteinuria by dipstick method. Another test was performed in the children with abnormal findings in the first sample with dipstick of the same brand, after a period of one-month. These children were also assessed by timed urine collection (i.e., 24 h urinary protein). In the first dipstick test, the prevalence of proteinuria in the studied population was 6.2% which persisted in 2.17% after second dipstick examination. No child in the studied group was found to have glycosuria. In our study, no statistically significant association was found between proteinuria and gender, body mass index, or hypertension. In our study, the prevalence of persistent proteinuria in school children (age group 12-14 years) in Kashmir valley was almost similar to the studies conducted in different parts of the world.

How to cite this article:
Malla HA, Bhat AM, Shazia B, Rather FA, Najar SM, Wani IA. Prevalence of proteinuria in school children (aged 12-14 years) in Kashmir valley, India, using dipstick method. Saudi J Kidney Dis Transpl 2016;27:1006-10

How to cite this URL:
Malla HA, Bhat AM, Shazia B, Rather FA, Najar SM, Wani IA. Prevalence of proteinuria in school children (aged 12-14 years) in Kashmir valley, India, using dipstick method. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2020 Dec 2];27:1006-10. Available from: https://www.sjkdt.org/text.asp?2016/27/5/1006/190877

   Introduction Top


Small amount of protein is excreted by most healthy children in their urine which represent, so-called physiologic proteinuria. [1] The protein excretion is highest in newborn infant, when corrected for body surface area, decreasing with the age until late adolescence when adult levels are reached. In newborn infants, immaturity of their renal function is the reason for the relatively high protein excretion which represents tubular proteinuria. [2]

Proteinuria not associated with any signs or symptoms of renal disease is termed asymptomatic or isolated proteinuria. Intermittent proteinuria denotes a term in which protein is detectable in only some of the patient's urine samples. It is physiological and may occur in stress, exercise, febrile illnesses, emotional disturbance, or cold. [3],[4] When protein appears in urine specimens collected in the upright posture but not during recumbency, it is called as orthostatic proteinuria. [3],[4] When protein is found in all the urine samples tested, weather in upright or recumbent posture, it is called as persistent proteinuria. It usually reflects renal or urinary tract disease and prompts further evaluation. [3],[4]

With the advent of fast screening methods for detecting urinary abnormalities (like dipsticks), the chances of early detection and management of many renal diseases have improved. In many studies, protein and red blood cells were used as markers of renal disorders. [5],[6]


   Materials and Methods Top


This study was conducted in school children of Kashmir valley in India, aged 12-14 years (i.e., middle school level 6 th , 7 th , and 8 th class over a period of 2 years). Both boys and girls were included in this study. The study was conducted by adapting multistage sampling procedures. To get the representative population from each randomized area, schools were chosen randomly, one from each area. The selected schools were visited during school hours. The children in the age group of 12-14 years were explained the whole exercise. Consent for this study was sought from the Directorate of School Education and respective school heads. The consent from Directorate of School Education was a must to undertake any activity in a particular school which comes under its jurisdiction. Consent from parents individually was not practically possible. To overcome this problem, a written intimation was sent to respective school heads beforehand, who in turn informed the parents. Considering the noninvasiveness of the study, only a few parents objected and their wards were excluded from the study).

Exclusion criteria

  1. Any recent/present history of fever, dysuria, hematuria, urinary retention, or clinical features such as pallor, puffiness of face, pedal edema (if present were excluded from the study)
  2. Drug history for hypertension, diabetes, nephrotic syndrome (if present were excluded from study).


After applying exclusion criteria, the healthy asymptomatic children were asked to get a fresh spot urine sample in a tightly screwed plastic bottle. The urine sample was checked for proteinuria and glycosuria by dipstick method. Children with proteinuria >1+ (30 mg/ dL) were selected for further evaluation. All positive cases were reassessed after one month, again for spot urine proteinuria and glycosuria by dipstick method (of the same brand) and for timed urine collection (24 h urinary protein).

Those children who had persistent proteinuria (i.e., proteinuria on two successive dipstick tests) and 24 h urinary protein >300 mg/day were again subjected to 24 h urinary protein for reconfirmation. Out of these, children with 24 h urinary protein >100 mg/day were subjected to biochemistry (serum urea, creatinine, protein, and albumin) and ultrasonography (for kidney size, corticomedullary differentiation and any other abnormality).


   Statistical Analysis Top


Metric data were described as mean ± standard deviation and percentages; nonmetric data were described as percentages. SPSS and MSExcel software were used for data analysis.


   Results Top


The study was conducted in nine districts of Kashmir valley over a period of two years. A total of 2068 children were screened for the presence of proteinuria with dipstick method. The proportion of children screened in each district was kept constant. Out of the children screened, 498 (24.1%) were from urban and 1570 (75.9%) from the rural background. The age group studied was 12-14 years (middle school level), of which 661 (32%) were 12 years, 702 (33.9) 13 years, and 705 (34.1) 14 years old. One thousand and two hundred two (58.1%) were males and 866 (41.9%) females [Table 1].
Table 1: Demographic characteristics of the studied population (n = 2068).

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Of the children screened, 128 (6.2%) were found to have proteinuria on single dipstick test. On second dipstick test, after an interval of one month, 45 (2.17%) children were found to have persistent proteinuria, whereas 83 (4.03%) had transient proteinuria [Table 2].
Table 2: Prevalence of proteinuria as per urinary DST.

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Those children who had persistent proteinuria (positive on second dipstick test) were also examined for timed urine collection (24 h urinary protein). Of the 45 children, 19 (42.2%) children were found to have 24 h urinary proteins more than 100 mg/dL. On repeat testing of these 19 children, 13 (68.4%) had persistent proteinuria more than 100 mg/day, and one child (5.3%) had subnephrotic proteinuria [Table 3].
Table 3: Proteinuria as per timed urine collection (24 h urinary protein) in children with persistent proteinuria on dipstick examination.

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Nineteen children with significant proteinuria on timed urine collection were also investigated for serum urea, creatinine, protein, and albumin levels. Of these, one (5.3%) child had deranged urea and creatinine and had subnephrotic proteinuria. All children had normal proteins and albumin. In these children, renal status was also assessed by ultrasonography, no abnormality was detected.

Out of the children who had positive single dipstick test, males were 70 (5.8%) and females 58 (6.7%). Persistent proteinuria was seen in 23 (1.91%) and 22 (2.54%), respectively [Table 4]. Proteinuria on single dipstick was seen in 34 (5.1%) in 12 years, 48 (6.8%) in 13 years, and 46 (6.5%) in 14 years age groups. Persistent proteinuria was seen in 15 (2.26%), 16 (2.27%), and 14 (1.98%), respectively.
Table 4: Gender-wise proteinuria in studied population.

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Among the urban group 29 out of 498 children (5.82%) and in rural group 99 out of 1570 (6.30%) children had proteinuria on first dipstick examination.

Among those children who were dipstick positive on a single examination, 104 (6.1%) had normal body mass index (BMI), 15 (7.0%) were underweight, eight (7.4%) were overweight, and one (3.6%) was obese. Persistent proteinuria was seen in 34 (1.97%) with normal BMI, seven (3.28%) with underweight, and four (3.7%) with overweight. No child with obesity was found to have proteinuria.

In children who had positive single dipstick test, 108 (6.1%) were normotensive, 14 (6.7%) were prehypertensive, and six (7.1%) were hypertensive. Persistent proteinuria was seen in 37 (2.0%), six (2.87%), and two (3.35%), respectively.

Measurement of blood pressure in children was performed with ageand size-appropriate equipment, and blood pressure values were interpreted according to normal values adjusted for age, gender, and height percentile as recommended by the 1996 Update on the Task Force Report on High Blood Pressure in Children and Adolescents: A Working Group Report from the National High Blood Pressure Education Program.


   Discussion Top


The study was conducted to know the prevalence of asymptomatic proteinuria in school children aged 12-14 years in nine districts of Kashmir valley. Two thousand and sixty-eight children were screened by dipstick method for the presence of proteinuria, 1202 were boys and 866 girls, 498 children were from urban and 1570 from rural background.

In our study, 128 children were detected to have proteinuria (>30 mg/dL) on single dipstick test out of 2068 children screened with prevalence of 6.2%. On the second urinalysis, proteinuria persisted in 2.17% of children. Our results were consistent with the study conducted by Trihono et al [7] who found proteinuria in 6.8% children, which on repeated urinalyses were determined as orthostatic in 0.4%, transient in 4.5%, and persistent proteinuria in 1.4% children. Moreover, Jafar et al in their study found the overall prevalence of proteinuria was 3.3% (2.7-3.9%). [8] Adesola et al. in their study found that proteinuria was present in 7.70% and persisted in 3.80% pupils. [9] Badeli et al in their study found that the prevalence was 3.2% for hematuria, 5.8% for proteinuria, and 0.13% for a mixture of proteinuria and hematuria. In the second urinalysis in patients with positive findings, hematuria, proteinuria, as well as mixed proteinuria and hematuria were 20.4%, 52.0%, and 2.0% correspondingly. In the third analysis of samples, the abnormal findings in all patients were 0.85% isolated hematuria, 1.57% isolated proteinuria, and 0.06% mixed hematuria and proteiuria. [10]

In our study, no statistically significant association was seen between gender, BMI, blood pressure, and proteinuria. This is in contradiction with the study conducted by Sung et al, which showed boys were 2.2 times more likely than girls to have proteinuria and childhood proteinuria was significantly associated with hypertension, hypercholesterolemia but not with an elevated BMI. [11]

The aim of our study was to know the prevalence of asymptomatic proteinuria in school children in Kashmir valley as no previous study was done in this part of the country. The children who had persistent proteinuria needs periodic follow-up for repeat urine examination, 24 h urinary protein, and renal biopsy (if needed) to know the cause of proteinuria in them. It would have been ideal to do further evaluation(± renal biopsy) in the single child who had subnephrotic range proteinuria and azotemia, however parents did not consented for the same as child was asymptomatic.

In addition, we need to broaden the agegroup and include primary school children (i.e., 6-11 years) and pre nursery children to know the prevalence of proteinuria in our pediatric population. Moreover, regular school screening programs need to be initiated to include basic physical checkup and noninvasive investigations (like urine examination) to detect any abnormality at an early stage so that appropriate preventive/curative actions are taken.

Conflict of interest: None declared.

 
   References Top

1.
Miltényi M. Urinary protein excretion in healthy children. Clin Nephrol 1979;12:21621.  Back to cited text no. 1
    
2.
Arant BS Jr. Developmental patterns of renal functional maturation compared in the human neonate. J Pediatr 1978;92:705-12.  Back to cited text no. 2
    
3.
Robson AM, Vehaskari VM. Proteinuria. In: Postlethwaite RJ, ed. Clinical Paediatric Nephrology. Bristol: Wright; 1986. p. 42-63.  Back to cited text no. 3
    
4.
James JA. Proteinuria and haematuria in children: Diagnosis and assessment. Paediatr Clin North Am 1976;23:807-16.  Back to cited text no. 4
    
5.
Bello AB. Proteinuria, haematuria and pyuria in asymptomatic school children. Clin Med 1988;1:14-6.  Back to cited text no. 5
    
6.
Onile BA, Awotoye EO, Odugbemi T. Combur9 - Test strips for detecting pyuria and significant bacteria. Niger Med Pract 1985;10:88.  Back to cited text no. 6
    
7.
PP Trihono, IS Timan, S Bektiwibowo, D Aulia, L Edwar. Screening urinalysis for proteinuria in school children. Paediatrica Indonesiana 2001;41(9-10):231-3.  Back to cited text no. 7
    
8.
Jafar TH, Chaturvedi N, Hatcher J, et al. Proteinuria in South Asian children: Prevalence and determinants. Pediatr Nephrol 2005; 20:1458-65.  Back to cited text no. 8
    
9.
Adesola A, Akebu O, Ademola O, et al. Proteinuria in the rural primary school setting in Nigeria-using combi test strips. Internet J Third World Med 2007;1-6.  Back to cited text no. 9
    
10.
Badeli H, Heidarzadeh A, Ahmadian M. Prevalence of hematuria and proteinuria in healthy 4 to 6 year old children in daycare centers of Rasht (Northern Iran). Iran J Pediatr 2009;19:169-72.  Back to cited text no. 10
    
11.
Sung FC, Lin CC, Lin RS, et al. Childhood mass screening of proteinuria, lipidemia and renal disease in Taiwan. 2001. (Abstract).  Back to cited text no. 11
    

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Correspondence Address:
Hilal Ahmad Malla
Department of Nephrology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India
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DOI: 10.4103/1319-2442.190877

PMID: 27752011

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