Medullary pyramids opacification in high-grade vesicoureteral reflux associated with posterior urethral valve

Posterior urethral valve (PUV) is a common cause of obstructive uropathy in children, leading to renal failure and frequently associated with vesicoureteral reflux (VUR), which can rapidly progress to end-stage renal disease (ESRD). We describe a rare presentation of high-grade VUR opacifying the renal pyramids in a 5-month-old child with sepsis and renal failure.