Socio-Demographic Factors Affect the Prevalence of Hematuria and Proteinuria Among School Children in Hualien, Taiwan: A Longitudinal Localization-Based Cohort Study

Abstract

Objective: Child hematuria/proteinuria is a risk factor for chronic kidney disease (CKD) in later life, and mass urinary screening could detect asymptomatic glomerulonephritis at an early stage. This study aimed to evaluate the longitudinal prevalence of hematuria/proteinuria and its association with socio-demographic factors among school children in Hualien, Taiwan.Methods: The study cohort consisted of first and fourth graders enrolled from 2008 to 2015 in Hualien. We combined the data from two consecutive health examinations to ensure the validity of the body mass index (BMI), urbanization, proteinuria, and hematuria grouping. Prevalence and health status differences between sex, age, BMI, and urbanization level were examined.Results: A total of 16,990 students within the same BMI and urbanization categories were included during the study interval. The prevalence of persistent hematuria was 1.0%. Fourth graders (odds ratio OR: 1.68, p = 0.002), girls (OR: 1.48, p = 0.014), and students from suburban/rural areas (OR: 1.99, and OR: 4.93, respectively; both p < 0.001) demonstrated higher hematuria risk. The prevalence of proteinuria was 0.2%. Fourth graders (OR: 4.44, p < 0.001) and students in suburban areas (OR: 0.27, p = 0.031) were associated with persistent proteinuria. After stratifying by age, the significant association remained. A higher risk of proteinuria was noted in underweight subjects (OR: 2.52, p = 0.023) among the fourth-grade students.Conclusion: The prevalence of hematuria/proteinuria in Hualien was higher than the average reported for Taiwan. Hematuria/proteinuria was significantly associated with sex, age, BMI, and urbanization. Our longitudinal results can provide information for future pediatric CKD prevention in Taiwan.

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“…Anthropometric measurements, including weight and height, were measured by school nurses prior to the dates of the physical examination. BMI was calculated, and students were classified into underweight, normal weight, overweight, and obese groups according to the age-sex-specific BMI cutoff levels in the new growth charts for Taiwanese children and adolescents, based on the standards of the World Health Organization, and health-related physical fitness related to health, developed by the Department of Health of Taiwan in 2010 [ 3 , 17 ]. Demographic data in the health examination records included age, sex, and residential setting.…”

“…This study was reviewed and approved by the Hualien County Government Education Bureau and the Protection of Human Subjects Institutional Review Board of Tzu Chi University and Hospital (REC No. IRB110-025-B) [ 17 ]. Written informed consent for participation in health examinations was obtained from the parents and guardians of all students.…”

Prevalence of hematuria and proteinuria in asymptomatic pediatric age group in suburban Chennai

“…Hematuria is defined as "the presence of more than 5 red blood cells (RBCs) per high power field collected in an uncentrifuged mid-stream urine collection." 1,2 It is classified into two: Macroscopic and microscopic, based on gross identification and detectable only following centrifugation, on direct testing through urine dipstick, or following direct visualization through urine microscopy, respectively. 3,4 Hematuria is rare in normal physiology, as the tightly knit structure of the glomerular basement membrane prevents blood from entering the urinary collecting system.…”

Epidemiologic Profile of Microscopic Hematuria in Iran: A Systematic Review and Meta-Analysis

“…In Iran, the age-standardized prevalence of CKD was 10924 per 100000 in 2017 and the age-standardized death rate was 16.6 per 100000 (18). In Taiwan, hematuria was significantly associated with sex, age, BMI, and urbanization (19). In Chronic Renal Insufficiency Cohort (CRIC) Study, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up.…”

“…In Taiwan, hematuria was significantly associated with sex, age, BMI, and urbanization ( 19 ). In Chronic Renal Insufficiency Cohort (CRIC) Study, hematuria was associated with a significantly higher risk of CKD progression and death in the first 2 years of follow-up.…”