Choosing Wisely:

Don’t order routine screening urinalysis in healthy, asymptomatic pediatric patients as part of routine well-child care.

Rationale and Comments: Research has shown that a high incidence of misinterpretation of positive screening urinalysis results leads to multiple testing and increased cost and family anxiety. This is counterbalanced by the low prevalence of chronic kidney disease 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 urinalysis in patients who are at high risk for chronic kidney disease, including but not necessarily limited to patients with a personal history of chronic kidney disease, acute kidney injury, congenital anomalies of the urinary tract, acute nephritis, hypertension, active systemic disease, prematurity, intrauterine growth retardation, or a family history of genetic renal disease, to improve the cost-benefit ratio.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric Nephrology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Preventive Medicine
  • References: • 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. A Cost-effectiveness analysis of screening urine dipsticks in well-child care. Pediatrics. 2010;125(4):660-663.
    • Hogg, R. Screening for CKD in children: a global controversy. Clin J Am Soc Neph. 2009;4:509-515.

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