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.
Urinalysis is important for pediatric patients who have one or more of the following risk factors for chronic kidney disease (CKD).
These conditions are associated with cumulative kidney damage.
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:
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:
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.
(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
Advise patients who are at increased risk for CKD to follow a program of risk reduction:
Refer to a nephrologist when the patient presents with one or more of the following conditions:
Find additional information on kidney and urologic diseases in children from the National Institute of Diabetes and Digestive and Kidney Diseases.
Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee. Recommendations for preventive pediatric health care. Pediatrics. 2007;120(6):1376.
Staples AO, Greenbaum LA, Smith JM, et al. Association between clinical risk factors and progression of kidney disease in children. Clinical Journal of the American Society of Nephrology. 2010;5(12):2172-2179.
Wong CS, Pierce CB, Cole SR, et al. Association of proteinuria with race, cause of chronic kidney disease, and glomerular filtration rate in the Chronic Kidney Disease in Children study. Clinical Journal of the American Society of Nephrology. 2009;4(4):812-819.
Page last updated: March 1, 2012