American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric Nephrology

View all recommendations from this society

July 16, 2018

Do not initiate a work up for hematuria or proteinuria before repeating an abnormal urine dipstick analysis (UA).

Abnormal dipstick urine analyses (UA) need to be repeated due to the high incidence of false positive tests. Abnormal urine testing results are often due to difficulties in obtaining a non-contaminated urine specimen or transient abnormalities seen with acute illnesses.


Repeating a UA prior to initiation of a full evaluation can decrease the need for additional testing, as described below:

  • Repeat a clean catch UA with microscopy x 3 for patients noted to have microscopic hematuria to look for evidence of chronic hematuria.
  • Repeat UA as a first AM void along with a urine protein/creatinine ratio in patients noted to have proteinuria on a random UA.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Pediatric Section on Nephrology Executive Committee (AAP SONp) and the American Society of Pediatric Nephrology Clinical Affairs Committee (ASPN CAC) utilized a four-stage process to develop its list. First, the two groups independently developed lists based on various common assessments, evaluations, and treatments in the practice of pediatric nephrology. During the second stage, the committee chairs consolidated the lists and then re-convened the individual committees to narrow the topics on the list. During the third stage, a final list of five practices was developed and consensus achieved by both committees that were found to be supported by evidence. The final stage occurred when the list was reviewed and approved by the AAP’s Executive Committee and the ASPN CAC.


Meyers KEC: Evaluation of hematuria in children. Urol Clin North Amer 31:559-573, 2004.

Lieu TA, Grasmeder HM 3rd, Kaplan BS: An approach to the evaluation and treatment of microscopic hematuria. Pediatr Clin North Amer 38:579-592, 1991.

Dodge WF, West EF, Smith EH, Bruce Harvey 3rd.:  Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr 88:327-347, 1976.