Monday, January 21, 2013

Urine dipstick screening

Early awareness of chronic kidney disease and prevention strategies have led to the mass screening at many places of urine dipstick for albuminuria in the general population. While in diabetics and hypertensives, this might be a very prudent approach, does mass screening really change outcomes? A recent commentary in CJASN discusses the screening concerns from a primary care's perspective. Some key points the authors make are:
1. Based on what a good screening test should be, urine dipstick doesn't cut it. The seven criteria for a good screening test are: target disease is prevalent, morbid; the screening test has to be low risk, cost effective and accurate and acceptable to patients; and we should have the ability to change the outcomes.
2. Many false positives are generate requiring not required follow ups ( especially in a time when we might not have that many nephrologists in near future)
3. Interestingly, are we really changing outcomes. Are we preventing them from getting to ESRD?

This might be a tide changer for many but some points they make are critical to look at. The threshold for screening needs to be higher ( DM, HTN, FMHx, edema - anything that raises the possibility of proteinuria) but as a routine screen for unselected people with no identified risk, the test (which is semi-quantitative and variable at best) probably cause more problems than it solves.  Generating inappropriate work up and referrals from a positive dipstick might be interesting to look at closely. Indication is most important in most cases.

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