We were beginning to understand what vesicoureteral reflux was, and why our daughter had been diagnosed, but we still didn’t understand what they meant by the grades of reflux? We were told that grade V was the most severe grade, but I still had no idea how that was determined, or what it really meant.
The grades of reflux are determined by the severity of the condition in each ureter. According to an article on Medscape, reflux grades are determined by the following standards:
Grade I – urine backs up into ureter only, and the renal pelvis (the renal pelvis is the area at the center of the kidney, urine collects here and is funneled into the ureter.) appears healthy, with sharp calyces (calyces are the collecting area for urine within kidney before it is passed through to the renal pelvis).
Grade II – urine backs up into the ureter, renal pelvis, and calyces. The renal pelvis appears healthy, with 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 renal 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 calyces are severely blunted.
The good news is that reflux resolves spontaneously before adolescents in most cases of Primary VUR, depending on the grade. The resolution rates for grade III and under is found to be up to 80%. As the grade of reflux increases, the odds of resolution decrease. Grade 4 only has a resolution rate of about 10%, and grade 5 has very little chance of resolving spontaneously. For us that meant that Lizzie’s reflux would probably not resolve over time, and would eventually require surgery. They explained to us that they would still give her body a chance to heal itself and that we would wait until age 4 or 5 before considering surgery unless there were other complications.