Author Affiliation: Academic Department of Renal Medicine, King's College Hospital, London, United Kingdom (firstname.lastname@example.org).
To the Editor: The study by Dr Vivante and colleagues1 showed persistent isolated microscopic hematuria to have a prevalence of 0.4% and 0.2% in asymptomatic young males and females, respectively, and to be associated with an adjusted hazard ratio of 18.5 for end-stage renal disease (ESRD) during 21 years of follow-up. The evaluation of isolated microscopic hematuria in adults is well described and widely accepted.2 However, the study by Vivante et al1 raises 2 major issues that are not yet defined and are similar to issues of using microalbuminuria and proteinuria for chronic kidney disease screening.3,4 The first relates to the necessity of population-based screening for hematuria with dipstick urinalysis. The arguments against screening are the relatively low prevalence of hematuria in young healthy individuals and the low absolute risk of isolated hematuria for ESRD. The arguments for screening derive from screening programs; in Japan, where annual urinalysis for schoolchildren and working adults has been used for years, the latest data suggest a decrease in ESRD from glomerulonephritis.5
Sarafidis PA. Microscopic Hematuria in Adolescents and Young Adults and Risk for End-stage Renal Disease. JAMA. 2011;306(18):1980-1981. doi:10.1001/jama.2011.1618