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

View all recommendations from this society

July 16, 2018

Don’t order routine screening urine analyses (UA) in healthy, asymptomatic pediatric patients as part of routine well child care.

Research has shown a high incidence of misinterpretation of positive tests of screening urinalysis lead to multiple testing and increased cost and family anxiety.  This is counterbalanced by the low prevalence of chronic kidney disease (CKD) and bladder cancer in children. One study showed that the calculated false positive/transient abnormality rate approaches 84%. These factors account for the low yield in detecting preventable and/or treatable problems in a healthy asymptomatic population with respect to cost and overall benefit.

 

With consideration of the currently available evidence, we recommend limiting screening UA in patients who are at high risk for chronic kidney disease (CKD), including but not necessarily limited to patients with a personal history of CKD, acute kidney injury (AKI), congenital anomalies of the urinary tract, acute nephritis, hypertension (HTN), active systemic disease, prematurity, intrauterine growth retardation, or a family history of genetic renal disease, to improve the cost-benefit ratio.


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.

Sources

Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee. Recommendations for preventive pediatric health care.  Pediatrics 2007; 120(6): 1376.

Kaplan RE, Springate JE, Feld LG. Screening dipstick urinalysis: a time to change. Pediatrics.1997; 100(6):919 –921.

Sekhar DL, Wang L,. Hollenbeak CS, Widome MD, Paul IM. Pediatrics 2010 125 (4); 660 – 663. A Cost-effectiveness Analysis of Screening Urine Dipsticks in Well-Child Care.

Hogg, R.  Screening for CKD in Children: A global controversy.  Clin J Am Soc Neph 2009 4:509-515.