title: Restructuring the Ikeda City school urinary screening system: report of a screening survey.
abstract: BACKGROUND
  Annual urinary screening is conducted at municipal kindergartens, elementary schools, and junior high schools in Ikeda City, Osaka, Japan (Ikeda City School System), and the results are reviewed by a general physician, but standards for when to recommend specialist referral have not been clear.
  
  
  METHODS
  In all children attending the Ikeda City School System in 2012, dipstick urinalysis of a first-morning urine specimen was recommended once or twice, and if a second urinalysis showed proteinuria (≥1+), the urinary protein/creatinine ratio was measured. If this showed ≥0.2 g/g of creatinine (g/gCr), it was recommended that the child be evaluated by a specialist at Ikeda City Hospital.
  
  
  RESULTS
  Urinary screening was performed in about 20% (388) of kindergarten, about 90% (5363) of elementary school, and about 86% (2523) of junior high school children living in Ikeda City. Urine samples were obtained from 387, 5349, and 2476 children, respectively. The urinary protein/creatinine ratio was ≥0.2 g/gCr in 13 children, including 1 elementary and 12 junior high children. In these 13 children, chronic nephritic syndrome (CNS) was suspected in 6 junior high school children, and of these, this was a new finding in 5, and renal biopsy was indicated in 3. In Ikeda City, the prevalence of CNS in elementary school children was <0.03%, the prevalence of CNS in junior high school children was 0.29%, and a renal biopsy was indicated in 0.14%. By eliminating the costs associated with assessment of the results by the Ikeda Medical Association, and by directly contracting with the testing company, the expenses paid by Ikeda City for the system itself decreased from 2,508,619 yen to 966,157 yen.
  
  
  CONCLUSIONS
  Incorporating the urinary protein/creatinine ratio into the school urinary screening system in the Ikeda City School System and clarifying standards for specialist referral has enabled restructuring of the system so that is efficient and its effectiveness can be assessed.
authors: Department of Nephrology, Ikeda City Hospital, Ikeda, Osaka, Japan. nkajiwara@ams.odn.ne.jp.
authors: Nobuyuki
authors: N
authors: Kajiwara
authors: Kazuyuki
authors: K
authors: Hayashi
authors: Takayuki
authors: T
authors: Fukui
authors: Satoko
authors: S
authors: Yamamoto
authors: Kensuke
authors: K
authors: Senzaki
authors: Shinichiro
authors: S
authors: Murakami
authors: Takuya
authors: T
authors: Kitamura
authors: Takato
authors: T
authors: Ueoka
authors: Mikito
authors: M
authors: Inoue
authors: Shigeki
authors: S
authors: Hayashi
authors: Keiko
authors: K
authors: Sakamoto
authors: Maiko
authors: M
authors: Yoshimoto
authors: Seiko
authors: S
authors: Asano
authors: Ichiro
authors: I
authors: Maki