To Elucidate the Natural History of Asymptomatic Urine Abnormality Based on Urinary Mass Screening for School Children in Taiwan

• Main Authors: Huang, Mei-Chen, 黃美真
• Other Authors: Lin DS, Chen Hsiu-Hsi
• Format: Others
• Language: zh-TW
• Published: 1997
• Online Access: http://ndltd.ncl.edu.tw/handle/05929377471529723132

碩士 === 國立臺灣大學 === 公共衛生學系 === 85 === Introduction:It was believed that urinary mass screening for school children can detectasymptomatic chronic glomerulonephritis(CGN) and an intervention is then givento arrest further progression to end stage renal failure(ESRF). Nonetheless, the efficacy of urinary mass screening remain equivocal. In the context of screenig theory, the incidence of ESRF is reduced by altering the natural history of asymptomatic urinary abnormality via an appropriate intervention program. It is worthwhile to estimate the transition of the natural history ofasymptomatic urinary abnormality, to elucidate factors affecting such transition, and to verify whether an appropriate intervention can enhance the efficacy of screening by altering the natural history.Methods:Data used in this study are from three-stage mass urinary screening for school children. The urinary abnormality is classified into four groups, hematuria (A), proteinruia (B), hematuria plus proteinuria (C) and sever abnormality (D). Descriptive epidemiology on age, sex and place are first depicted to explore the transition between D and other types of urinary abnormality (non-D). We thenapply Time- dependent Markov Chain and Mover-Stayer Models to quantify the transition of the natural history for urinary abnormality. Factors affecting such transitions are analyzed by general estimation equation (GEE). McNemar'stest is performed to examine whether an appropriate intervention program canefficaciously alter the natural history of urine abnormality by reverting D to non-D.Results:The incidence rate of A, B, C and D is incresing with age, peaking at 11-13 years old, and falling off onwards. For A, B and C, the incidence rate in femaleis higher than that in male but such difference is not so significant for D. Theprevalence of A, B and C is also increasing with age whereas the prevalence of Dremains stable regardless of age. This suggests that as time goes a proportionof D might revert to non- D. Such reversion is more likely to happen for female. Such proposition can be supported by taking into account dynamic progression of urinary abnormality. Rates of urinary abnormality are not only increasing with age but the difference between B and D or C and D are enlarged with time and little differences between female and male are found for D.Results from Time- dependent Second-order Mover-Stayer Models show that thetransition probabilty from non-D to D is decreasing with time and male is largerthan female whereas transition probability from D to non-D is increasing with time and female is higher than male. It should be noted that approximate 60%-70%urinary abnormality can be reverted from D to non-D in male or female. All odds ratios (transition from non-D to D versus D to non-D) calculated fromMcNemar's method lie between 0.23 (95%CI: 0.09-0.56) and 0.46 (95%CI: 0.24-0.90)which significantly reject the null hypothesis that there is a balance equilibrium between progression from non-D to D and from D to non-D. In conjunction with the prevalence of D and a large proportion of reversion from Dto non-D found from Mover-Stayer Models we support the efficacy of intervention program in altering the natural history.Using GEE estimation, the odds of the transition from non-D to D increase 13.4%(95%CI: 10.8%-16.1%) per year and male is 1.5 times likely to have the corresponding transition than female. This is consistent with the finding from the descriptive results. After adjusting for sex and age, significant serum factors affecting the transition from non-D to D and from D to non-D include systolic blood pressure, diastolic blood pressure, creatinine, IGA, albumin, total protein. Thses findings are congruent with histopathological results for MPGN and IgA Nephropathy.Conclusion:Although results from this study found there is a proportion of urine abnormality can revert from severe urine abnormality (D) to moderate (non-D) anappropriate intervention program is able to make more contribution to such transition to prevent further progression. This suggests that urinary mass screening is still valuable in early detection of asymptomatic urinary abnormality. The further study should be launched to validate whether sever urine abnormality is a good surrogate endpoint for ESRD.