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FYI: Choosing Wisely in nephrology :

August 2, 2018

Pediatric nephrology experts collaborated to assemble a list of Five Things Physicians and Patients Should Question based on common assessments, evaluations and treatments.

The AAP Section on Nephrology Executive Committee and American Society of Pediatric Nephrology independently developed lists, consolidated and narrowed topics to five supported by evidence:

  1. Don’t 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 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 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.

Read the rationale behind the list, references and possible exceptions at

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