Bladder and ureter reflux examination

1.UTI Laboratory examination showed pyuria and urine bacterial culture was positive. Protein, red blood cells, white blood cells and various casts can be found in the urine test of RN. Renal function test is normal or abnormal. 2. Ultrasound examination can evaluate the function of the junction between bladder and ureter, observe the dilatation and peristalsis of ureter and the continuity of bladder bottom, and observe the morphological and substantive changes of renal pelvis and kidney. Someone inserted a catheter and injected gas (such as CO2) during B-ultrasound. If gas enters the ureter, VUR can be diagnosed. Color Doppler ultrasound is used to observe the function of the junction and the position of the ureter opening, but B-ultrasound has limitations in detecting the scar of the upper ureter and can't grade VUR. 3.x-ray examination (1) cystourethrography (MCU)? This is the basic method commonly used to diagnose VUR, and it is also the "gold standard" of grading. Five-level classification proposed by the International Reflux Committee: Grade I: Urinary reflux is limited to ureters. Grade II: Urine refluxes to ureter and renal pelvis, but there is no dilatation, and the renal calyceal vault is normal. Grade ⅲ: ureter is slightly and moderately dilated and/or twisted, renal pelvis is moderately dilated, and fornix is not (or) slightly obtuse. Grade ⅳ: the ureter is moderately dilated and twisted, the renal pelvis and calyx are moderately dilated, the fornix angle disappears completely, and most of the calyx remains nipple impression. Grade ⅴ: The ureter is severely dilated and twisted, the renal pelvis and calyces are severely dilated, and most calyces do not show nipple impression. (2) Intravenous pyelography (IVP)? It can further diagnose whether there is renal atrophy and renal scar formation. In recent years, it is considered that high-dose intravenous pyelography plus X-ray tomography can better display scars. 4. Radionuclide examination (1) Radionuclide bladder imaging? There are direct determination method and indirect determination method, which are used to determine VUR. (2) DMSA scanning technology? It is the only "gold standard" for diagnosing RN in children, especially children over 5 years old. Coldraich classifies renal scars into four grades according to the signs of DMSA scanning photography: Grade I: Grade I and Grade II scars. Grade II: There are more than two scars, but the renal parenchyma between scars is normal. Grade III: Diffuse damage of the whole kidney, similar to obstructive nephropathy, that is, the whole kidney is atrophied, with or without scar on the outline of the kidney. Grade Ⅳ: At the end stage, the kidney atrophy, with little or no DMSA uptake (less than 10% of total renal function).