Grade I Reflux does not reach the renal pelvis; varying degrees of ureteral dilatation Grade II Reflux reaches the renal pelvis; no dilatation of the collecting system; normal fornices Grade III Mild or moderate dilatation of the ureter, with or without kinking; moderate dilatation of the collecting system; normal or minimally deformed fornices Grade IV Moderate dilatation of the ureter with or without kinking; moderate dilatation of the collecting system; blunt fornices, but impressions of the papillae still visible Grade V Gross dilatation and kinking of the ureter, marked dilatation of the collecting system; papillary impressions no longer visible; intraparenchymal reflux

VUR: Vesicoureteral Reflux; VCUG: Voiding Cystourethrography Adapted with permission from Lebowitz RL et al. [87].

Table 5: Grading system for VUR on VCUG, according to the International Reflux Study Committee

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