Practical approach to diuretic renography in children: Techniques, interpretation, and pitfalls.

Diuretic renography remains central to evaluating suspected urinary tract obstruction in children, yet interpretation varies across centers. Modern pediatric practice benefits from standardized acquisition and analysis, including harmonized hydration, furosemide timing, and drainage parameters such as half-time (T½), normalized residual activity (NORA), and parenchymal transit time (PTT). Diuretic renography in children, including its indications, practical patient preparation and acquisition protocols, and interpretive framework linked to clinical decision points are discussed. Key protocol choices (F-15, F-0, F + 20/30), bladder management, minimization of sedation, and motion control are also reviewed, and pitfalls described at the end. Consistent technique-adequate hydration, standardized furosemide dosing, dynamic acquisition with post-void/post-upright positioning/delayed images, and quantitative assessment-improves reproducibility and reduces equivocal studies. NORA complements T½ by accounting for kidney size and residual activity; PTT helps separate obstructive from non-obstructive delay and may predict outcomes after pyeloplasty. Special populations (infants, neurogenic bladder, post-operative states) require tailored protocols and cautious interpretation of quantitative parameters. A practical, physiology-based approach to pediatric diuretic renography reduces variability and aligns imaging with urologic management. Standardized technique and transparent reporting of drainage metrics (T½, NORA, PTT) should be performed widely to optimize care and facilitate multi-center research.