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Grades of Vesicoureteral Reflux*

Grade

Characteristics

I

Only the ureters are involved but not the renal pelvis.

II

Reflux reaches the renal pelvis, but the calyces are not dilated.

III

The ureter and renal pelvis are dilated, with minimal or no blunting of calyces.

IV

Dilation increases, and the sharp angle of the calyceal fornices is obliterated.

V

The ureter, pelvis, and calices are grossly dilated.

Papillary impressions frequently are absent.

* As defined by the International Reflux Study in Children.

Lebowitz RL, Olbing H, Parkkulainen KV, et al: International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 15(2):105-109, 1985. doi: 10.1007/BF02388714