Choosing Wisely Offers Advice on Appropriate Nephrology Testing in Children

Itasca—The American Academy of Pediatrics (AAP), as part of the Choosing Wisely® campaign, today released a list of specific nephrology tests and procedures that are commonly ordered but not always necessary when treating children for kidney-related conditions.

Unnecessary testing often generates false positive findings that can lead to more testing, expense, inconvenience for patient and family, and even to painful invasive diagnostic or therapeutic procedures.

The AAP Section on Nephrology and the American Society of Pediatric Nephrology (ASPN), after careful review and analysis, produced five targeted evidence-based recommendations in "Five Things Physicians and Patients Should Question".

"Communication between physicians and parents is important to health of all children, but even more so when a child experiences a chronic nephrological illness," said AAP Section on Nephrology Chairperson, Dr. Doug Silverstein. "Sometimes parents or physicians want to ensure all available testing is done, but unnecessary testing can create more fear, cost and risk for children. Good communication and discussion of options can help reduce the likelihood of unnecessary testing."

"For example, repeating a blood pressure measurement before undertaking an extensive work-up for hypertension will often avoid unnecessary testing and the risk of false positive results leading to more testing and anxiety for patients and families," said, ASPN President, Dr. Patrick Brophy.

The Choosing Wisely recommendations include:

• Do not order routine screening urine analyses in healthy, asymptomatic pediatric patients as part of routine well child care.
• Do not initiate a work up for hematuria or proteinuria before repeating an abnormal urine dipstick analysis.
• Avoid ordering follow-up urine cultures after treatment for an uncomplicated urinary tract infection in patients that show evidence of clinical resolution of infection.
• Do not initiate an outpatient hypertension work-up in asymptomatic pediatric patients prior to repeating the blood pressure measurement.
• 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.

The list, Five Things Physicians and Patients Should Question, is available through the Choosing Wisely website.

Choosing Wisely® is an initiative of the ABIM Foundation, which seeks to promote conversations between clinicians and patients in choosing care that is supported by evidence; does not duplicate other tests or procedures already received; is free from harm; and truly necessary.

At least 80 medical specialty societies have published more than 500 recommendations of overused tests and treatments as a result of the initiative, launched in 2012.

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About AAP:

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.

About ASPN:

The American Society of Pediatric Nephrology (ASPN) is a professional society composed of pediatric nephrologists whose goal is to promote optimal care for children with kidney disease and to disseminate advances in the clinical practice and basic science of pediatric nephrology. ASPN currently has over 600 members, making it the primary representative of the Pediatric Nephrology community in North America. For more information, visit www.aspneph.org.

About ABIM Foundation:

The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org.