Clinicians should question these 5 pediatric nephrology practices, according to the American Academy of Pediatrics and the American Society of Pediatric Nephrology, the organizations that compiled the list for the Choosing Wisely initiative.

  1. Do not order routine screening urine analyses in healthy, asymptomatic pediatric patients as part of routine well child care. Instead, Choosing Wisely recommends limiting screening urine analysis to patients who are at high risk for chronic kidney disease (CKD).
  2. Do not initiate a work up for hematuria or proteinuria before repeating an abnormal urine dipstick analysis due to the high rate of false positives.
  3. Avoid ordering follow-up urine cultures after treatment for an uncomplicated urinary tract infection (UTI) in patients who 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 (PICC) in pediatric patients with advanced (Stage 3-5) CKD/end-stage renal disease without consultation with a pediatric nephrologist due to goals to avoid adverse events, preserve long-term vascular access, and avoid unnecessary and costly procedures.