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June 2010

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.

ORIGINAL ARTICLES
41. Reaven G, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996;334:374-81. 42. Stout RW, Bierman EL, Ross R. Effect of insulin on proliferation of cultured primate arterial smooth muscle cells. Circ Res 1975;36:319-27.

50 Years Ago in THE JOURNAL OF PEDIATRICS Voiding Urethrography: An Integral Part of Intravenous Urography
Hope JW, Jameson PJ, Michie AJ. J Pediatr 1960;56:768-73

his is a fascinating report describing the use of voiding urethrography as a valuable study to diagnosis abnormalities 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 been detected by intravenous pyelography alone. Two of the boys had anterior urethral valves, 1 had posterior urethral valves, 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 is now called a voiding cytourethrogram (VCUG) continues to be an important radiologic study to diagnosis lower urinary tract lesions today. At the present time, a VCUG is used to dene the lower urinary tract anatomy in multiple settings including urinary tract infections, diagnosis and management of veiscoureteral reux, hydronephrosis, obstructive uropathy, neurogenic bladder, dysfunctional voiding, as well as other lower tract pathology. A radionucleotide 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 report published 50 years ago point out that the comfort and privacy of the child are important aspects of a successful voiding 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 now completely or nearly completely obsolete. Currently, a renal ultrasound is typically used as the initial radiographic study to evaluate the anatomy of the upper urinary tract. Other radiographic studies to evaluate the anatomy and function of the upper urinary tract include radionucleotide scans including a mercapto acetyl tri glycine or dimercaptosuccinic acid renal scan, computed tomography scans with or without contrast, and/or imaging with an magnetic resonance imaging or magnetic resonance angiography. Sharon P. Andreoli, MD Division of Pediatric Nephrology James Whitcomb Riley Hospital for Children Indianapolis, Indiana
10.1016/j.jpeds.2010.01.034

Elevated Ambulatory Blood Pressure in a Multi-Ethnic Population of Obese Children and Adolescents

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