Vesicoureteral reflux (VUR)
- a congenital
malformation caused by aberrant insertion of the ureter into the bladder.
- Patients who
have low-grade (I, II) unilateral VUR usually experience few urinary tract
infections.
- Furthermore,
unilateral grade I to II VUR usually (>85% of cases) resolves spontaneously
within 5 years.
- Bilateral,
severe (grades III through V) VUR often is complicated by recurrent urinary
tract infections and pyelonephritis, placing the patient at risk for renal
scarring and insufficiency.
- The pyramids are kidney
structures, like hills protruding into pelvis. The fornices are the 'negative
space' of the pelvis and are like sharp fingers stabbing into pelvis. To
determine grade III, don't look at shape of pelvis, look at fornices - if they
are blunted, that's grade III.
Grading
- Grade I: Urine backs up into the
ureter only, and the renal
pelvis appears healthy, with sharp calyces.
- Grade II: Urine backs up into the
ureter, renal pelvis, and calyces. The
renal pelvis appears healthy and has sharp calyces.
- Grade III: Urine backs up into the ureter and
collecting system. The ureter and
pelvis appear mildly dilated, and the
calyces are mildly blunted.
- Grade IV: Urine backs up into the ureter and
collecting system. The ureter and
pelvis appear moderately dilated, and the calyces are moderately blunted.
- Grade V: Urine backs up into the ureter and
collecting system. The pelvis severely
dilates, the ureter appears tortuous, and the calyces are severely blunted.