Intrarenal Reflux Diagnosed by Contrast-enhanced Voiding Urosonography - a Case Report

Objective − Intrarenal reflux (IRR) is the main cause of renal injury in children with vesicoureteral reflux (VUR), and has an important role in the pathogenesis of scarring and reflux nephropaty (RN). Using voiding cystourethrography (VCUG) IRR is usually detected in high grades of VUR. Our case demonstrates the possibility of visualizing IRR in a child with low-grade VUR using contrast-enhanced voiding urosonography (ceVUS). Case Report − We report the case of a four-month-old girl with Klebsiella pneumoniae febrile urinary tract infection (UTI) who was diagnosed by ceVUS with VUR grade II on the right kidney, with IRR strongest in the lower pole. A 99m Tc 2.3-dimercaptosuccinic acid (DMSA) renal scan, which was performed 8 months after the UTI revealed a small scar on the lower pole of the right kidney, where IRR was found by ceVUS. Conclusion − Our case report showed that not only the grade of reflux but also the presence of IRR is important to predict the severity of the clinical picture and the development of possible scarring. It is important to find IRR because it may be connect with renal scars. VUR with IRR should be managed actively to decrease the chances of renal scarring or the development of new scars.