Descreva o achado como no laudo. A resposta aponta uma das categorias publicadas, com a probabilidade e o trecho que a decide.
Categorias
Reescritas a partir da fonte e citadas
I
1 de 5
Grade I
Reflux into a non-dilated ureter only (urine refluxes solely into the ureter, which is not dilated).
CondutaLowest-risk grade: conservative observation with the goal of keeping urine sterile; continuous antibiotic prophylaxis individualized/selective (e.g. infants or recurrent febrile UTI) rather than routine, given high spontaneous-resolution rates.
RiscoHigh spontaneous resolution: about 75% (range 70-80%) of grade I-II VUR resolves spontaneously by age 5.
Reflux reaching the renal pelvis and calyces (ureter and pelvis) without dilatation.
CondutaConservative/low-grade approach: observation with sterile-urine maintenance; antibiotic prophylaxis individualized rather than uniformly applied.
RiscoFavorable: about 75% (range 70-80%) of grade I-II VUR resolves spontaneously by age 5.
Mild-to-moderate dilatation of the ureter and pyelocalyceal system with only mild/minimal blunting of the calyceal fornices.
CondutaLower end of 'high-grade': continuous antibiotic prophylaxis is generally recommended; endoscopic subureteric injection considered if intervention is needed and breakthrough infections occur.
RiscoModerate resolution: grade III-IV resolves spontaneously in roughly 60-70% over 5 years when reflux is unilateral and detected before age 2.
verificadoInternational system of radiographic grading of vesicoureteric refluxNBK563262 (grade III = mildly dilated ureter/pelvocalyceal system, minimal calyceal blunting; 'for grades III and IV ... VUR will resolve in 60% to 70% over 5 years' if unilateral and found before age 2; prophylaxis, endoscopic injection).
IV
4 de 5
Grade IV
Moderately tortuous, mildly-to-moderately dilated ureter with dilatation of the renal pelvis and calyces and blunting of the calyces, while the papillary impressions are still visible.
CondutaHigh-grade: antibiotic prophylaxis typically recommended; surgical correction (ureteral reimplantation, ~98-99% success) or endoscopic injection (~59% success) for recurrent/breakthrough infection or non-resolution.
RiscoLower spontaneous resolution (grade III-IV ~60-70% over 5 years only if unilateral and detected before age 2); open/robotic reimplantation is highly successful (~98-99%), while endoscopic injection succeeds in ~59%.
verificadoInternational system of radiographic grading of vesicoureteric refluxNBK563262 (grade IV = tortuous moderately dilated ureter, calyceal blunting with preserved papillary impression; grade III-IV 60-70% over 5 yr if unilateral/early; reimplantation 98-99%, endoscopic grade IV 59%).
V
5 de 5
Grade V
Severely (grossly) dilated, very tortuous ureter with marked pyelocalyceal dilatation and loss of the papillary impressions/fornices.
CondutaHighest-grade: surgical intervention (open ureteral reimplantation) is usually preferred; antibiotic prophylaxis for very young infants pending repair; endoscopic injection an alternative (~62% success).
RiscoSpontaneous resolution without surgery is rare; open/robotic reimplantation success is around 80% (lower than the 98-99% seen in lower grades), while endoscopic injection succeeds in ~62%.