The most common system of grading reflux severity includes five grades, from Grade I (least severe) to Grade V (most severe):
- Grade I results in urine reflux into the ureter only.
- Grade II results in urine reflux into the ureter and the renal pelvis, without swelling of the top of the ureter (hydronephrosis).
- Grade III results in reflux into the ureter and the renal pelvis, causing mild hydronephrosis.
- Grade IV results in moderate hydronephrosis.
- Grade V results in severe hydronephrosis and twisting of the ureter
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