Urinary schistosomiasis-associated morbidity in schoolchildren detected with urine albumin-to-creatinine ratio (UACR) reagent strips.

Abstract

OBJECTIVE:

To evaluate urine albumin-to-creatinine ratio (UACR) reagent strips for detection of urinary tract pathology (UTP) associated with urinary schistosomiasis in schoolchildren from Zanzibar.

PATIENTS AND METHODS:

Sixty-six schoolchildren were examined for urinary schistosomiasis and UTP using urine reagent strips (Hemastix, urine microscopy and portable ultrasonography. The UACR was estimated using Microalbustix; univariate and logistic regression methods were used to test for statistical associations.

RESULTS:

Prevalence of egg-patent schistosomiasis was 65.2% while 77.3% had micro-haematuria and 66.1% had a least one ultrasound-identified UTP. Abnormal UACR (> or =3.4 mg/mmol) was frequent (88.4%) but an unsatisfactory identifier of UTP, albeit highly sensitive: sensitivity (SS) = 100.0%, specificity (SP) = 23.8%, positive predictive value (PPV) = 71.9%, negative predictive value (NPV) = 100.0%. When only severely abnormal UACR was considered (> or =33.9 mg/mmol), SS decreased while SP improved: SS = 58.5%, SP = 61.9%, PPV = 75.0%, NPV = 43.3%.

CONCLUSION:

Abnormal and severely abnormal UACRs were strongly associated with egg-patent urinary schistosomiasis and UTP, although via different mechanisms: respectively, from venous blood released directly into the urine from bladder wall perforations, and from leaching sera released from chronic egg-induced lesions throughout the urinary tract. From a control perspective, Microalbustix reagent strips are therefore best applied in pre-screening protocols allowing selection, or rather confident exclusion, of schoolchildren with urinary schistosomiasis for more detailed investigations.

• Authors: J Russell Stothard, Jose C Sousa-Figueiredo, I Simba Khamis, Amadou Garba, David Rollinson
• Journal: Journal of pediatric urology (J Pediatr Urol) Vol. 5 Issue 4 Pg. 287-91 (Aug 2009) ISSN: 1873-4898 [Electronic] England
• PMID: 19168393 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Reagent Strips
• Creatinine

Topics

• Adolescent
• Albuminuria (diagnosis, epidemiology, urine)
• Child
• Creatinine (urine)
• Endemic Diseases
• Hematuria (diagnosis, epidemiology, urine)
• Humans
• Logistic Models
• Mass Screening (methods)
• Morbidity
• Predictive Value of Tests
• Prevalence
• Reagent Strips
• Schistosomiasis haematobia (diagnostic imaging, epidemiology, urine)
• Sensitivity and Specificity
• Tanzania (epidemiology)
• Ultrasonography