A voiding cystourethrogram in a 2-year-old girl with febrile urinary tract infections shows reflux into a mildly dilated ureter and renal pelvis. The calyces show blunting of the fornices but the papillary impressions remain visible. What is the grade of vesicoureteric reflux?
- A Grade II
- B Grade III ✓
- C Grade IV
- D Grade V
Correct answer: B. Grade III
Explanation
In the international grading system, grade III reflux shows reflux into a mildly to moderately dilated ureter and pelvis with blunting of the fornices while the papillary impressions are preserved. Grade II reaches the pelvis without any dilatation or forniceal blunting. Grade IV shows moderate dilatation with loss of the papillary impressions, and grade V adds gross tortuosity of the ureter and complete effacement of the collecting system. Preserved papillae therefore fix the answer at grade III.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.