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Special Feature: Screening Series |
Departments of * Nephrology and Public Health, Osaka University Graduate School of Medicine, Suita, Osaka, Department of Nephrology, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, Ibaraki, Dialysis Unit, University Hospital of the Ryukyus, Okinawa, || Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, ¶ First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, and ** Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Correspondence: Dr. Enyu Imai, Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Phone: 81-6-6879-3632; Fax: 81-6-6879-3639; E-mail: imai{at}medone.med.osaka-u.ac.jp
In the early 1970s, mandatory kidney disease screening was started with urinalysis in the Japanese health examination program for all workers and school-age children. In 1983, nationwide urinalysis screening in adults aged 
40 yr was mandated in the community-based health examination program. Because glomerulonephritis was an endemic disease and the leading cause of end-stage renal disease in Japan until 1997, the urinalysis in the annual health examination program aimed for early detection of glomerulonephritis and early referral of patients to physicians. To the programs, measurement of serum creatinine was added for detection of chronic kidney disease in 1992 for adults aged 40 yr. Kidney disease screening and early intervention brought reduction of progressive glomerulonephritis or an increase in remission. Thus, in children and adults aged 
45 yr, the number of patients with end-stage renal disease from glomerulonephritis has declined, and the mean age of patients with new end-stage renal disease has increased significantly. In 1998, the leading cause of end-stage renal disease was shifted from glomerulonephritis to diabetic nephropathy as a result of lifestyle changes in the Japanese population; however, the present comprehensive kidney disease screening in the health examination program for detection of glomerulonephritis must be continued, because even in 2005, 27.3% of newly developed end-stage renal disease was from glomerulonephritis. An additional kidney disease screening program should also be established to target patients with high risk for diabetes, hypertension, and metabolic syndrome, because 42% of newly introduced renal replacement cases were from diabetic nephropathy in 2005.
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