Neonatal dipstick test could reveal early renal disease
MedWire News: Dipstick urinalysis and follow-up of abnormal results during the neonatal period could result in early diagnosis of renal disease, report Iranian researchers.
Their study revealed that among 375 asymptomatic neonates who received dipstick testing, two were eventually diagnosed with underlying kidney disease and "potentially benefited from early identification," they suggest.
"In spite of advanced methods for prenatal diagnosis, such as ultrasonography and molecular biology, some of these diseases may be missed or undiagnosed," say Behnaz Falakaflaki (Zanjan University of Medical Science) and colleagues.
Although the dipstick test is relatively simple, it represents "one of the most important advances in the current diagnosis procedure in pediatric nephro-urology," write the researchers in the journal Pediatrics and Neonatology.
It is also easy to perform, relatively cheap, gives an immediate result, and does not require extensive personnel training, they continue, explaining that it is the best way to approach the most common urologic conditions in pediatric patients: urinary tract infection, hematuria, and proteinuria.
From 2007 through 2008, Falakaflaki and colleagues collected urine samples from 400 healthy infants during the first 3 days of life. A trained nurse read the reaction of the dipstick strip, and those with positive protein, blood, ketone, glucose, or nitrite reactions received a follow-up urine investigation and further referral to a nephrology clinic if their abnormal result remained.
A total of 375 (94%) of samples were normal and 25 (6%) neonates had abnormalities on the initial dipstick test (proteinuria, positive blood). After 1 week, the rate of proteinuria had decreased (to 1.3%) but the rate of positive blood remained the same (0.3%).
The main cause of proteinuria is physiological and often transient, comments the research team, observing that as expected, by the end of the first week of life, its prevalence had decreased to normal.
Of note, male neonates (55%) had a significantly higher proportion and severity of proteinuria compared with female neonates, while there was no difference in blood-positive results by gender.
Follow-up investigations in those with persistent abnormalities revealed one infant had ureteropelvic junction obstruction and another had vesicoureteral reflux.
While some countries have not found mass screening of asymptomatic patients to be cost effective (eg, the USA), others (Japan, Taiwan, Korea) operate such programs and credit them with the detection of otherwise symptomless conditions.
The issue of cost effectiveness requires further study, conclude Falakaflaki et al.
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By Sarah Guy