Choosing Wisely:

Don’t initiate a workup for hematuria or proteinuria before repeating an abnormal urine dipstick analysis.

Rationale and Comments: Abnormal dipstick urinalysis needs 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 urinalysis prior to initiation of a full evaluation can decrease the need for additional testing, as described below: • Repeat a clean catch urinalysis with microscopy x 3 for patients noted to have microscopic hematuria to look for evidence of chronic hematuria. • Repeat urinalysis as a first a.m. void along with a urine protein/creatinine ratio in patients noted to have proteinuria on a random urinalysis.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Nephrology and the American Society of Pediatric Nephrology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Urologic
  • References: • Meyers KEC. Evaluation of hematuria in children. Urol Clin North Amer. 2004;31:559-573.
    • Lieu TA, Grasmeder HM 3rd, Kaplan BS. An approach to the evaluation and treatment of microscopic hematuria. Pediatr Clin North Amer. 1991;38:579-592.
    • Dodge WF, West EF, Smith EH, Bruce Harvey 3rd. Proteinuria and hematuria in schoolchildren: epidemiology and early natural history. J Pediatr. 1976;88:327-347.

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