The Japanese government started universal screening of urinalysis for all employees in 1973, because they were concerned about the increase in ESRD patients. In 2004, 83% of employees participated in this program. The Ministry of Education, Science and Culture started a mandatory urinalysis screening program for school children in 1974, and in 1983, the Ministry of Health and Welfare started the universal screening of urinalysis of senior citizens aged 40 and older, and 44% of residents participated in this program. Urinalysis in the annual health check program initially started with a simple goal of early referral of patients with glomerulonephritis to family physicians. Glomerulonephritis was an endemic disease in Japan, and the leading cause of ESRD until 1997. It has been the second leading cause of ESRD since 1998 and still occupied about 27.3% of new ESRD in Japan in 2004. These screening programs for CKD seem to work effectively against glomerulonephritis. Among people with age 45 and younger, the number of children and individuals with ESRD due to glomerulonephritis has been declining and the mean age of new ESRD patients has increased significantly. The targeted screening program for CKD to a particular region or generation, does not seem to work effectively for Japanese because risk factors related to glomerulonephritis have not been well identified. However, a new systemic screening program may be needed because the paradigm of the kidney disease setting has shifted from endemic glomerulonephritis to epidemic diabetes and hypertension due to lifestyle modification.
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