Bilateral vesicoureteric reflux disease
Recurrent urinary tract infection.
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Moderate dilatation of pelvicalyceal system bilaterally as well as both ureters, more on the right side. Normal renal parenchyma bilaterally with good corticomedullary differentiation. Blunting of right renal calyces and preserved at the left one. Both ureters are moderately dilated and tortuous anong their courses with no evidence of obstruction.
Mild free ascites.
This case represents moderate dilatation of both pelvicalyceal systems and ureters. These features are suggestive of right grade III and left grade IV vesicoureteric reflux disease. MR urography shows the morphological changes in the ureters and pelvicalyceal system that helps in grading VUR and differentiated it from primary megaureter and obstructive uropathy.
Voiding cystourethrogram is the primary diagnostic procedure for evaluation of vesicoureteric reflux (not yet performed) and should be performed after the first well-documented urinary tract infection up to the age of 6 years. Vesicoureteric reflux disease affects renal parenchyma and can lead to reflux nephropathy if untreated.