Diagnosis of Vesicoureteric Reflux and Reflux Nephropathy

FIGURE 8-12 International system of radiographic grading of vesicoureteral reflux (VUR). The severity of VUR is most frequently classified according to the International Grading System of Vesicoureteral Reflux, using a standardized technique for performance of voiding cystourethrography. The definitions of this system are illustrated in Figure 8-4 and are as follows. In grade I, reflux only into the ureter occurs. In grade II, reflux into the ureter, pelvis, and calyces occurs. No dilation occurs, and the calyceal fornices are normal. In grade III, mild or moderate dilation, tortuosity, or both of the ureter are observed, with mild or moderate dilation of the renal pelvis. No or only slight blunting of the fornices is seen. In grade IV, moderate dilation, tortuosity, or both of the ureter occur, with moderate dilation of the renal pelvis and calyces. Complete obliteration of the sharp angle of the fornices is observed; however, the papillary impressions are maintained in most calyces. In grade V, gross dilation and tortuosity of the ureter occur; gross dilation of the renal pelvis and calyces is seen. The papillary impressions are no longer visible in most calyces [18].