Screening for urinary abnormalities in healthy school children living in an African urban megacity

BACKGROUND: Urinary screening is a useful and non-invasive tool for identifying occult kidney disease in asymptomatic children and may be an important initial step in preventing progressive kidney disease. However, this screening is not commonly performed in children living in low-resource countries, including the Democratic Republic of the Congo (DRC). This study aimed to determine the prevalence of albuminuria and its associated factors among healthy school children living in DRC. In addition, the study examined the prevalence of urinary abnormalities detected by dipstick in this population. METHODS: This cross-sectional study was conducted in 17 schools in Kinshasa. A multistage sampling procedure was applied, and 497 healthy school children aged 6 to 16 were randomly recruited. Anthropometric and clinical data were collected. Using a single-sample measurement, urinary albumin-to-creatinine ratio (ACR) was determined by an immunoturbidimetric method, and dipstick tests were performed to detect other urinary abnormalities (leukocyturia, nitrituria, proteinuria, hematuria). Albuminuria was defined as ACR ≥ 30 mg/g. Logistic regression was used to identify clinical factors associated with albuminuria. RESULTS: Among the 497 school children (208 boys and 289 girls), 58 had single-sample albuminuria, corresponding to a prevalence of 11.7%. There was no significant association between albuminuria and clinical variables based on univariate logistic regression analysis. Dipstick urinary abnormalities were present in 113 children (22.7%). Specifically, leukocyturia, nitrituria, proteinuria, and hematuria were detected in 14.3%, 1.6%, 8.2%, and 1.6% of participants, respectively. Leukocyturia and nitrituria were significantly more common among girls (p < 0.001). CONCLUSION: Urinary abnormalities are common among asymptomatic school children in the DRC. Although a single measurement was performed, these results raise the relevant question of the usefulness of urinary screening in children living in resource-limited settings. However, the feasibility, cost, and potential benefits of such a program warrant further evaluation in these settings.