Background/Objective: Voiding cystourethrography is the gold-standard diagnostic tool for detecting vesicoureteral reflux and is commonly requested by pediatricians, pediatric nephrologists, emergency pediatricians, and pediatric urologists. However, VCUG is invasive, exposes patients to radiation, and carries a risk of iatrogenic urinary tract infection (UTI). This study aimed to assess the correlation between VCUG findings and factors such as age, gender, referring specialist, and clinical indication for the procedure to identify opportunities to reduce unnecessary VCUG examinations. Methods: A retrospective analysis of 197 pediatric patients who underwent VCUG over 12 months at the Institute for Child and Youth Health Care of Vojvodina was conducted. Results: The Mann–Whitney U test showed no statistically significant age difference between patients with normal (median: 2.5 years) and pathological (median: 3 years) VCUG findings (Z = −0.415, p = 0.678). The chi-square test showed that patients with a single urinary tract infection (10 patients) and other clinical indications (24 patients) had a higher chance of normal VCUG findings (0.041 and 0.011, respectively). Binary logistic regression analysis showed that patients referred by pediatric urologists were 2.06 times more likely to have pathological VCUG findings than those referred by pediatric nephrologists (p = 0.013, OR = 2.059; 95%CI: 0.166–3.634). Regarding clinical indications, the chance that VCUG findings would be normal was 2.7 times higher in patients with other indications than in patients with recurrent UTIs (p = 0.038, OR = 2.729; 95% CI: 1.055–7.059). Conclusions: Pediatric urologists tend to refer patients for VCUG more selectively than pediatric nephrologists. Avoiding VCUG in cases of a single UTI or non-specific clinical indications could significantly reduce the number of unnecessary procedures, minimizing patient exposure to radiation and potential complications.

With the increasing life expectancy of individuals with Down syndrome (DS), kidney disease has emerged as an important yet under-recognized contributor to long-term morbidity and mortality in this population. This narrative review summarizes current knowledge regarding the developmental, structural, histopathological, and clinical aspects of renal involvement in DS. A literature search was conducted, and studies addressing renal structure, function, development, or pathology in individuals with DS (clinical studies, autopsy studies, case reports, and experimental studies) were included. Available evidence indicates that renal involvement in DS extends beyond congenital anomalies to include altered nephrogenesis, acquired glomerulopathies, and progressive functional impairment. Histopathological studies of fetal kidneys suggest altered nephrogenesis and delayed renal maturation in DS, potentially resulting in reduced nephron endowment. However, the long-term functional consequences of these developmental findings remain uncertain. Reported acquired glomerular diseases are heterogeneous and include IgA nephropathy, focal segmental glomerulosclerosis, membranous nephropathy, ANCA-associated glomerulonephritis, and several rarer entities. Conventional renal biomarkers may underestimate kidney dysfunction in DS because of altered body composition and reduced muscle mass, while evidence regarding novel biomarkers such as NGAL and KIM-1 remains limited. Renal involvement in DS is multifactorial and likely reflects the interplay between disturbed nephrogenesis, developmental renal abnormalities, and acquired renal disease, resulting in increased renal vulnerability throughout life. Improved awareness, earlier nephrological surveillance, and validation of sensitive renal biomarkers may facilitate earlier detection of kidney injuries and improve long-term renal outcomes in individuals with DS.