Figure 721

The severity of vesicoureteral reflux (VUR) as graded in 1981 by the International Reflux Study Committee. When children have pyelonephritis, the possibility of VUR should always be considered. Childhood vesicoureteral reflux is five times more common in girls than in boys. It has a genetic background: several cases occasionally occur in the same family. Unless detected and corrected early, especially the most severe forms of this class and when urine is infected (one episode of pyelonephritis suffices), childhood VUR is a major cause of cortical scarring, renal atrophy, and in bilateral cases chronic renal insufficiency. The International Reflux Study classifies reflux grades as follows: I) ureter only; II) ureter, pelvis, and calyces, no dilation, and normal calyceal fornices; III) mild or moderate dilation or tortuosity of ureter and mild or moderate dilation of renal pelvis but no or slight blunting of fornices; IV) moderate dilation or tortuosity of ureter and moderate dilation of renal pelvis and calyces, complete obliteration of sharp angle of fornices but maintenance of papillary impressions in majority of calyces; V) gross dilation and tortuosity of ureter, gross dilation of renal pelvis and calyces. Papillary impressions are no longer visible in the majority of calyces. (From International Reflux Study Committee [9]; with permission.)

How To Reduce Acne Scarring

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