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Indications for cystography in children. Morphological abnormalities and functional defects
Víctor M García Nieto1, María Candelaria Darias Martin2, Teresa Moraleda Mesa3
1Sección de Nefrología Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain.
Anales De Pediatria
|February 24, 2026
Summary
Basic kidney function tests can help determine if children need cystography after a urinary tract infection (UTI). Maximum urinary osmolality (UOsm) is useful for ruling out severe vesicoureteral reflux (VUR) in children without a UTI history.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Cystography and urethrography were standard after a first UTI, but indications are now clinical.
- Ultrasound is widely used for assessing urinary tract abnormalities.
- Kidney function tests can potentially refine cystography indications in children.
Purpose of the Study:
- To evaluate the role of basic kidney function tests in guiding cystography decisions in pediatric patients.
- To assess the diagnostic accuracy of kidney function tests in identifying vesicoureteral reflux (VUR).
Main Methods:
- A cross-sectional study of 175 children undergoing ultrasound for UTIs or morphological abnormalities.
- Assessed maximum urinary osmolality (UOsm), and urinary albumin/creatinine and NAG/creatinine ratios.
- Defined significant morphological abnormalities (SMAs) based on pelvic diameter.
Main Results:
- Vesicoureteral reflux (VUR) was found in 57 children; 56.1% had SMAs, and 75% had abnormal UOsm.
- "UTI + significant SMA" had an 89% negative predictive value for VUR.
- Combining "SMAs or reduced maximum UOsm" predicted all severe VUR cases (grades IV-V).
Conclusions:
- In children with UTI and SMAs, maximum UOsm testing may not be necessary before cystography.
- Maximum UOsm is valuable for excluding severe VUR in children without a UTI history.
- Renal tubular function tests, alongside clinical and sonographic data, can optimize cystography indications.
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