The first clinical and epidemiological programme on renal disease in Bolivia: a model for prevention and early diagnosis of renal diseases in the developing countries

Background. The prevalence and incidence of renal diseases in developing co untries are not known. This lack of knowledge is an obstacle to the adoptio n of preventive measures which may be of great value in a social and econom ic environment where treatment options for end-stage renal failure are simp ly not available to the vast majority of the population Urinalysis, a simpl e and inexpensive test, remains a cornerstone in the evaluation of the kidn ey and may also be easily employed in mass screening for renal abnormalitie s in a developing country. Methods. An educational campaign on renal diseases was conducted in three s elected areas of Bolivia. Urine samples were collected and sent to one of 2 1 participating clinical centers. Fresh urine specimens were screened using a dipstick for chemical analysis and by microscopic urinalysis after centr ifugation. In those patients in whom urinary abnormalities were found, furt her investigations were carried out in order to define the diagnosis; these patients were enrolled in a 3-year follow-up program. Results. Apparently healthy subjects (n = 14 082) were referred to the Firs t Clinical and Epidemiological Program of Renal Diseases from rural and met ropolitan areas in Bolivia. Urinary abnormalities were detected in 4261 sub jects at first screening. The most common form of urinary abnormality was h ematuria, which was found in 2010 (47% of positively screened subjects). Ot her renal abnormalities were leukocyturia (41%) and proteinuria (11%). Conf irmatory tests and further clinical studies were then carried out in 1019 p eople. On a second screening 35% of the subjects had no urinary abnormaliti es; in the remaining people the following diagnosis were made: asymptomatic urinary-tract infection (48.4%), isolated benign hematuria (43.9%), chroni c renal failure (1.6%), renal tuberculosis (1.6%). Other diagnosis were: re nal stones 1.3%, diabetic nephropathy 1% and polycystic kidney diseases 1.9 %. Conclusions. This study helped define for the first time the frequency of a symptomatic renal diseases in Bolivia. It shows that it is possible to scre en a large population of patients at relatively low cost, providing the fra mework for further action that may help in the prevention and timely diagno sis of renal diseases.