IFGH 2012: Screening Program in Children for Prevention of Chronic Renal Disease and Hypertension in the Peruvian Andes

Authors:HurtadoA.^1,2 ,PandoJ.^4,PadillaE.^2,3,FigueroaJ.^2,3

Author Affiliations: 1 Head of the Department of Nephrology, Arzobispo Loayza Hospital, Lima-Peru 2 Cayetano Heredia Peruvian University, Lima-Peru
3 Family Medicine Resident
4 Clinical Lecturer, Department of Paediatrics and Child Health, University College Cork (UCC), Ireland

Option 1– Scientific / Empirical Research Findings Presented as – Poster

Aims:

• To identify children and adolescents at risk for Renal Disease based on an early detection of proteinuria.
• To slow the progression of chronic kidney disease (CKD) by early intervention after diagnosis. 


Methods: 


In September 2010, the Screening was started in the rural town of Llamellin (Peruvian Andes at 3200 meters above sea level) among school children.

Screening:


1) Weights and heights 


2) Proteinuria: A clean-catch, midstream morning urine specimen was collected from the children 


The urine was screened for:


a) proteinuria and hematuria using standard urinary dipstick

b) microalbuminuria using micraltest 


3)Arterial Blood Pressure 


Results: 


Between September and November 2010, 754 children from 5 schools in Llamellin were evaluated. In the first screening 0,5% had proteinuria, 4,9% had hematuria, 11, 3% had microalbuminuria. In the second screening none had hematuria or proteinuria, but 1,45% had microalbuminuria. Positive microalbuminuria in both screening was found in 11 children. 
In 2011, 149 children were screened. 13 children (8.7%) had positive microalbuminuria in 3 screenings.
All children with persistent microalbuminuria had normal creatinine and renal ultrasounds
In total, 14 children were started treatment with Enalapril. 9 children received treatment for at least 6 months. From these, 3/9 had negative microalbuminuria at the end of 6 months, in 3/9 microalbuminuria had diminished and in the 3 remaining, microalbuminuria persisted the same. 


Discussion/conclusions/ implications:
Populations living at high altitude such as in Llamellin (Peru), are exposed to many of the factors responsible for the development of CKD: low birth weight, malnutrition, and chronic hypoxia which recently has been recognized as responsible for renal injury.
Our results show a higher frequency of urinary abnormalities compared to those reported previously in children. Short term follow up of these children, show good response to treatment. 
Community-based mass screening, targeting populations at high risk for CKD, should prove to be cost-effective in the long term.