Patients on maintenance hemodialysis are at increased risk for HGBV-C infection. This virus produces persistent infections, which may be transmitted by transfusions but may also be transmitted by other means.

Plasma albumin leaks into urine as a result of glomerular hypertension and basement membrane injury, while urinary type IV collagen derives from mesangial matrix and glomerular basement membrane. The purpose of this study was to elucidate the pathophysiological significance of these urinary microproteins as an indicator of cardiovascular organ injuries in hypertension. In health-checkup participants without diabetes, proteinuria, or microhematuria, and who were not being treated for hypertension or any other disease at the time of enrollment, urinary albumin and type IV collagen were measured and their relations to organ injuries and cardiovascular risk factors were evaluated. Of 1,079 subjects (40-to 65-year-old; 256 men and 823 women) enrolled in the study, 120 (11.1 %) had untreated hypertension exceeding 140190 mmHg. Urinary albumin was positively correlated with both age (r=0.16, p<0.001) and systolic blood pressure (r=0.27, p<0.001). Urinary type IV collagen was not only positively correlated with age (r=0.12, p<0.001) and diastolic blood pressure (r=0.14, p<0.001) but also negatively correlated with blood hemoglobin (r=-0.12, p<0.001). Urinary albumin, but not type IV collagen, had a significant relation to electrocardiographic signs of left ventricular hypertrophy (p=0.012) and retinal arteriosclerosis on fundoscopy (p <0.001). Thus both albumin and type IV collagen would seem to have increased in association with age and hypertension in this cohort. It is suggested that urinary albumin is an indicator not only of renal injury, but also possibly of development of cardiac hypertrophy and arteriosclerotic changes. Urinary type IV collagen, on the other hand, may be associated with renal tissue injuries that affect erythrokinetics. (Hypertens Res 2000; 23: 459-466)

Patients on maintenance haemodialysis in four dialysis centres were tested for markers of hepatitis C virus (HCV) infection. Antibody to HCV (anti-HCV) was detected by the second-generation enzyme immunoassay in 142 (26%) of the 543 patients and HCV RNA in 117 (22%) of whom four were without detectable anti-HCV in serum. Seventy-seven (66%) were infected with HCV of genotype II/1b, 31 (27%) with genotype III/2a and eight (7%) with genotype IV/2b, in a distribution similar to that in blood donors who carried HCV asymptomatically. Haemodialysis patients had high HCV RNA titres comparable to those of patients with chronic hepatitis C. HCV RNA was detected in 96 (26%) of the 365 patients with a history of transfusion more frequently than in 21 (12%) of the 178 without previous transfusion (P < 0.001). In transfused patients, frequencies of anti-HCV and HCV RNA increased in parallel with the duration of haemodialysis. The frequency of anti-HCV in non-transfused patients, however, did not change appreciably with the duration of haemodialysis up to 22 years. The patients with anti-HCV had a higher frequency of HCV RNA in serum than symptom-free blood donors with anti-HCV (113/142 or 80% vs 109/166 or 66%, P < 0.01) and the patients with HCV RNA had a lower frequency of elevated aminotransferase levels than blood donors with HCV RNA (5/113 or 4% vs 27/109 or 25%, P < 0.001). These results indicate that transfusion is a significant cause of HCV infection in patients on maintenance haemodialysis, and that these patients are prone to establish the HCV carrier state after infection.

The increase in recent years in the number of dialysis patients in Japan is thought to be mainly a result of westernization of the diet and an increase in the number of patients with diabetic nephropathy and hypertensive nephrosclerosis due to the aging population. Early detection and early treatment of kidney diseases are important for reducing the rate of increase in the number of dialysis patients, but many patients with kidney disease, diabetes mellitus or hypertension do not undergo medical examinations until the end stage of renal failure because of the lack of subjective symptoms. Thus, renal screening tests are important to reduce the incidence of kidney disease, though follow-up is important as well as renal screening tests. In this paper, the present status of renal screening tests in Japan is decribed, and problems in follow-up of persons who have shown abnormalities in results of basic health examinations, in the situation regarding examinations at medical institutions and in renal screening tests in Utsunomiya City (1) are discussed. Significance and problems in renal screening testsRenal screening tests are considered to be important for early detection and early treatment of kidney diseases and thus for reducing the incidence and the rate of progression of chronic renal failure. However, there are many problems at present concerning renal screening in Japan. One problem is that the methods used for urinalysis differ and the levels of accuracy are not the same. This problem must be resolved. Moreover, although urinalysis is carried out regularly for children up to the age of 15 years, this is not the case for people over the age of 15 years, and many people over the age of 15 years who show abnormalities in the results of urinalysis do not undergo subsequent examinations. It has also been pointed out that there is a lack of consistency in guidelines for subsequent management of company workers who show abnormalities in the results of urinalysis performed as part of health examinations for company employees. Moreover, both the percentage of adults in Japan who undergo health examinations and the percentage of adults showing abnormalities in results of urinalysis who undergo further examinations are low. It has also been pointed out that there is no evidence of early detection of renal disease being useful for preventing the progression of disease. Another current problem is that the number of specialists in Japan is not sufficient to cope with referrals of all persons who show abnor-

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