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Considering Tests? Choose Wisely.

December 10, 2018 The American Academy of Pediatrics (AAP) Section on Nephrology, and the Clinical Affairs Committee of the American Society of Pediatric Nephrology (ASPN have developed a list of five important, evidence-based recommendations for physicians when it comes to ordering or recommending specific tests and procedures for nephrology patients. The recommendations are designed to cut down on the frequency of unnecessary diagnostics and procedures that can be of little value or utility for individual patients.

Michael L. Moritz, MD, FAAP, clinical director of the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh was part of the multidisciplinary committee the developed the recommendations for physicians.

Part of the AAPs broader Choosing Wisely® program, the recommendations for pediatric nephrologists include the following five areas:
  1. Do not order routine screening urine analyses in healthy, asymptomatic pediatric patients as part of routine well-child care.
  2. Do not initiate a work-up for hematuria or proteinuria before repeating an abnormal urine dipstick analysis.
  3. Avoid ordering follow-up urine cultures after treatment for an uncomplicated urinary tract infection in patients that show evidence of clinical resolution of infection.
  4. Do not initiate an outpatient hypertension work-up in asymptomatic pediatric patients prior to repeating the blood pressure measurement.
  5. Do not place central lines or peripherally inserted central lines in pediatric patients with advanced (Stage 3-5) chronic kidney disease/end-stage renal disease without consultation with pediatric nephrology due to goals to avoid adverse events, preserve long-term vascular access, and avoid unnecessary and costly procedures.