Kidney Function Tests in Health Checkups for Specified Skilled Workers: A Case-based Suggestion.

Approximately 250,000 foreign nationals reside in Japan under the specified skilled worker (SSW) visa category. Due to Japan's aging population and declining birth rate, a labor shortage is anticipated, prompting an increase in the intake of SSWs. All SSWs are required to undergo pre-arrival health screenings, but renal function assessments, such as the estimated glomerular filtration rate (eGFR), are not currently included. We present a case of a woman in her early 20s from Myanmar who developed severe anemia and renal dysfunction after arriving in Japan as an SSW. Before arrival, an initial health checkup identified anemia with a hemoglobin level of 10.3 g/dL, but renal function tests were not conducted. Ten months later, her hemoglobin had dropped to 7.7 g/dL, and her serum creatinine level was elevated to 7.83 mg/dL. Subsequent testing revealed severe renal dysfunction, and imaging showed extensive cysts in the right kidney and atrophy of the left kidney, suggesting a congenital malformation. She required immediate hemodialysis. This case highlights the gap in SSW health screenings, where renal function tests are omitted. Given Japan's rising number of SSWs, we emphasize the importance of including kidney function assessments, such as eGFR, in pre-employment health checkups. Early detection could prevent delays in diagnosing conditions like chronic kidney disease. As hemodialysis initiation often complicates treatment continuity after returning home, appropriate screening is essential for patient safety and improved health outcomes. In conclusion, we suggest updating the pre-employment health checkup protocol for SSWs to include kidney function tests to address this critical gap.