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The negative predictive value of the first two tests was 93%, which indicates that cystography may not be necessary, in those cases with normal maximum urine osmolality and albuminuria.75 In a longitudinal study including children with differing grades of VUR we observed that, at the time of diagnosis, the maximum urine osmolality was reduced in 69.5% of them61 but at the end of the follow-up period it was only present in 19.5%.76 At the beginning, the concentrating capacity defect was related to the degree of VUR and at the end of the follow up, the defect in concentration was related to the loss of parenchyma rather than the initial degree of VUR

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