Groups Suggest 5 Practices to Avoid in Pediatric Nephrology

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

The American Academy of Pediatrics and the American Society of Pediatric Nephrology have released five pediatric nephrology practices that clinicians should strive to avoid, as part of the Choosing Wisely campaign. Among them:

• Well-child visits should not include routine urinalysis for asymptomatic patients.

• Work ups for hematuria or proteinuria shouldn't be initiated before repeating abnormal urine dipstick analysis (UA), given the high false-positive test rate for UA.

• For patients with signs of clinical resolution of urinary tract infection following treatment, follow-up urine cultures aren't necessary.

• For asymptomatic patients, clinicians should repeat blood pressure measurements three times at one visit and at two more visits to document persistently elevated blood pressure. Before this, outpatient hypertension work up shouldn't be initiated.

• For children and adolescents with advanced chronic kidney disease or end-stage renal disease, central lines or peripherally inserted central lines shouldn't be placed without first consulting with pediatric nephrology.