Considerations for Pediatric Patients

Because routine urinalysis is no longer recommended as part of routine pediatric care, some children who would benefit from a urinalysis may not undergo this simple test. As a result, some children with kidney disease may go undetected or not receive appropriate follow-up.

Q & As on Using Urinalysis to Screen for Kidney Disease in Pediatric Patients

• Who needs urinalysis as part of well child care?
• Why is it important to screen pediatric patients for CKD?
• What tests should be used to screen for CKD?
• How is GFR estimated in children?
• What preventive strategies are recommended for children at risk for CKD when results do not indicate CKD?
• When should patients be referred to a pediatric nephrologist?

Who needs urinalysis as part of well child care?

Urinalysis is important for pediatric patients who have one or more of the following risk factors for chronic kidney disease (CKD).

• Family history of hereditary kidney disease and lipid disorders
• Congenital urinary tract abnormalities
• Electrolyte or acid-base abnormalities
• Systemic inflammatory/metabolic or infectious disorders
• Growth disorders
• SGA (small for gestational age) or born premature
• Rickets
• At-risk for type 1 or 2 diabetes
• Body mass index (BMI) > 95th percentile
• Sustained high blood pressure
• Polyuria or inappropriately dilute urine
• Gross hematuria
• Dysfunctional voiding, urinary incontinence, or prolonged enuresis
• Symptoms of a urinary tract infection
• Back or flank pain suggestive of a stone or pyelonephritis
• Edema
• Fever or acute illness of unknown origin (in infants and toddlers)
• Recurrent dehydration

These conditions are associated with cumulative kidney damage.

Why is it important to screen pediatric patients for CKD?

A majority of diseases that cause kidney failure and related cardiovascular complications among adults have their origins in childhood. Early detection and appropriate treatment may:

• Delay the onset of CKD in those at increased risk,
• Slow CKD progression, and
• Slow the development of cardiovascular disease in people with CKD.

What tests should be used to screen for CKD?

Urine and blood tests are used to detect CKD. Begin with a standard urine dipstick. If the dipstick is positive for albumin, confirm the presence of albumin by performing a second dipstick on the first morning void, at least one or two weeks later.

For patients with two or more positive urine dipsticks completed one to two weeks apart, obtain two additional tests:

• Urine albumin-to-creatinine ratio (UACR), and
• Serum creatinine to determine the estimated glomerular filtration rate (eGFR).

How is GFR estimated in children?

A child's GFR can be estimated using the Bedside IDMS-Traceable Schwartz equation. To perform the calculation, you will need the patient's serum creatinine level and height.

Bedside IDMS-traceable Schwartz GFR calculator for children

(for use with enzymatic creatinine methods that have been calibrated to be traceable to IDMS)

GFR (mL/min/1.73 m²) = (0.41 × Height) / Serum creatinine

• Height in cm
• Serum creatinine in mg/dL

What preventive strategies are recommended for children at risk for CKD when results do not indicate CKD?

Advise patients who are at increased risk for CKD to follow a program of risk reduction:

• Refer children with BMI >85th percentile to see a registered dietitian or to enter a weight loss program
• Repeat blood pressure tests for all children with BP > 90th percentile, and treat as necessary
• Counsel against smoking (when appropriate)
• Screen annually for CKD

When should patients be referred to a pediatric nephrologist?

Refer to a nephrologist when the patient presents with one or more of the following conditions:

• Proteinuria
• Microscopic hematuria, combined with proteinuria
• Sustained hypertension
• Decreased eGFR
• Polyuria or inappropriately dilute urine
• Evidence of a stone in the urinary tract
• Recurrent cystitis or pyelonephritis

For more information

Find additional information on kidney and urologic diseases in children from the National Institute of Diabetes and Digestive and Kidney Diseases.