VCUG demonstrating bilateral Grade II (non-dilating)<unk> . The following procedures may be used to diagnose<unk> : * Cystography * Fluoroscopic voiding cystourethrogram (VCUG) * Abdominal ultrasound * Technetium-99m Dimercaptosuccunic Acid (DMSA) Scintigraphy An abdominal ultrasound might suggest the presence of<unk>  if ureteral dilatation is present; however, in many circumstances of<unk>  of low to moderate, even high severity, the sonogram may be completely normal, thus providing insufficient utility as a single diagnostic test in the evaluation of children suspected of having<unk> , such as those presenting with prenatal hydronephrosis or urinary tract infection (UTI). VCUG is the method of choice for grading and initial workup, while RNC is preferred for subsequent evaluations as there is less exposure to radiation. A high index of suspicion should be attached to any case where a child presents with a urinary tract infection, and anatomical causes should be excluded. A VCUG and abdominal ultrasound should be performed in these cases DMSA scintigraphy is used for the evaluation of the paranchymal damage, which is seen as cortical scars. After the first febrile UTI, the diagnostic role of an initial scintigraphy for detecting the damage before the VCUG was investigated and it was suggested that VCUG can be omitted in children who has no cortical scars and urinary tract dilatation. Early diagnosis in children is crucial as studies have shown that the children with<unk>  who present with a UTI and associated acute pyelonephritis are more likely to develop permanent renal cortical scarring than those children without<unk> , with an odds ratio of 2.8. Thus<unk>  not only increases the frequency of UTIs, but also the risk of damage to upper urinary structures and end-stage renal disease. Severity<unk>  <unk>  is graded according to severity. * Grade I –<unk>  into non-dilated ureter * Grade II –<unk>  into the renal pelvis and calyces without dilatation * Grade III – mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices * Grade IV – dilation of the renal pelvis and calyces with moderate ureteral tortuosity * Grade V – gross dilatation of the ureter, pelvis and calyces; ureteral tortuosity; loss of papillary impressions The younger the patient and the lower the grade at presentation the higher the chance of spontaneous resolution. Approximately 85% of grade I & II<unk>  cases will resolve spontaneously. Approximately 50% of grade III cases and a lower percentage of higher grades will also resolve spontaneously.
Vesicoureteral reflux
Obstructive uropathy
Ureteric stricture
Glomerulonephrosis
Hydronephrosis
Urethral stricture
Pyelonephritis
Emphysematous cystitis