June 2010 ORIGINAL ARTICLES

39. Taittonen L, Uhari M, Nuutinen M, Turtinen J, Pokka T, Akerblom HK.

Insulin and blood pressure among healthy children: cardiovascular risk

in young Finns. Am J Hypertens 1996;9:193-9.

40. Gupta AK, Clark RV, Kirchner KA. Effects of insulin on renal sodium

excretion. Hypertension 1992;19(suppl I):I-78-82.

50 Years Ago in THE JOURNAL OF PEDIATRICS

Elevated Ambulatory Blood Pressure in a Multi-Ethnic Population

41. Reaven G, Lithell H, Landsberg L. Hypertension and associated meta-

bolic abnormalities: the role of insulin resistance and the sympathoadre-

nal system. N Engl J Med 1996;334:374-81.

42. Stout RW, Bierman EL, Ross R. Effect of insulin on proliferation of cul-

tured primate arterial smooth muscle cells. Circ Res 1975;36:319-27.

Voiding Urethrography: An Integral Part of Intravenous UrographyHope JW, Jameson PJ, Michie AJ. J Pediatr 1960;56:768-73

This is a fascinating report describing the use of voiding urethrography as a valuable study to diagnosis abnormal-ities of the lower urinary tract and as an important tool to aide in interpretation of the intravenous pyelogram. The

authors describe 4 boys in whom abnormalities were found on the voiding urethrography that would not have beendetected by intravenous pyelography alone. Two of the boys had anterior urethral valves, 1 had posterior urethralvalves, and 1 had severe phymosis causing urinary tract infections. The report focused on evaluation of the urethra.

This report is quite interesting because a voiding urethrography that has expanded to also study the bladder and isnow called a voiding cytourethrogram (VCUG) continues to be an important radiologic study to diagnosis lower uri-nary tract lesions today. At the present time, a VCUG is used to define the lower urinary tract anatomy in multiplesettings including urinary tract infections, diagnosis and management of veiscoureteral reflux, hydronephrosis,obstructive uropathy, neurogenic bladder, dysfunctional voiding, as well as other lower tract pathology. A radionu-cleotide VCUG has been developed to avoid the exposure to ionizing radiation that occurs with a standard VCUG.However, the radionucleotide VCUG lacks the anatomic detail provided by a standard VCUG. The authors of the re-port published 50 years ago point out that the comfort and privacy of the child are important aspects of a successfulvoiding urography, and this continues to be appreciated today to obtain an accurate VCUG.

In stark contrast, the intravenous pyelogram (which the voiding urethrography was meant to complement) is nowcompletely or nearly completely obsolete. Currently, a renal ultrasound is typically used as the initial radiographicstudy to evaluate the anatomy of the upper urinary tract.

Other radiographic studies to evaluate the anatomy and function of the upper urinary tract include radionucleotidescans including a mercapto acetyl tri glycine or dimercaptosuccinic acid renal scan, computed tomography scans withor without contrast, and/or imaging with an magnetic resonance imaging or magnetic resonance angiography.

Sharon P. Andreoli, MDDivision of Pediatric Nephrology

James Whitcomb Riley Hospital for ChildrenIndianapolis, Indiana

10.1016/j.jpeds.2010.01.034

of Obese Children and Adolescents 935