FIGURE 4.  25-y-old patient with chronic renal insufficiency due to reflux nephropathy. (A) CT scan shows atrophic left kidney (arrow) with dilated pelvis. (B) First-minute parenchymal image shows small scarred left kidney and also upper and lower parenchymal defects of right kidney (differential renal function: left, 31%; right, 69%). (C) Indirect radionuclide cystography shows massive left VUR. (D) VCUG shows massive left pyeloureteral reflux. (E) Sagittal sonogram shows dilatation of distal left ureter (arrow).