Summary about Disease
Ureteropelvic Junction (UPJ) obstruction is a blockage or narrowing where the ureter (the tube that carries urine from the kidney) connects to the renal pelvis (the collecting system of the kidney). This obstruction impedes urine flow from the kidney to the bladder, potentially causing kidney swelling (hydronephrosis) and, if left untreated, kidney damage.
Symptoms
Symptoms can vary depending on the severity of the obstruction and the age of the patient. Some individuals may be asymptomatic. Common symptoms include:
Flank pain (pain in the side or back) that may come and go, especially after drinking large amounts of fluids.
Abdominal pain.
Nausea and vomiting.
Urinary tract infections (UTIs).
Kidney stones.
Blood in the urine (hematuria).
In infants and young children: failure to thrive, irritability, or a palpable abdominal mass.
High blood pressure
Causes
UPJ obstruction can be caused by:
Congenital: Present at birth. This is the most common cause, often due to abnormal muscle development at the UPJ.
Acquired: Developing later in life. This can be caused by:
Scar tissue from previous surgery or infection.
Kidney stones.
External compression from blood vessels.
Tumors (rare).
Medicine Used
While medication cannot directly correct the physical obstruction, certain medications may be used to manage symptoms or related complications:
Pain relievers: For managing flank or abdominal pain (e.g., acetaminophen, ibuprofen, or stronger pain medications if necessary).
Antibiotics: To treat urinary tract infections.
Antihypertensives: To manage high blood pressure, if present. Definitive treatment usually involves surgical correction.
Is Communicable
No, UPJ obstruction is not a communicable disease. It is not contagious and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent congenital UPJ obstruction. For acquired UPJ obstruction, these precautions may help in preventing the condition:
Managing and preventing kidney stones through diet and hydration.
Prompt treatment of urinary tract infections.
How long does an outbreak last?
UPJ obstruction is not an outbreak-related disease. It is a chronic condition that persists until treated. Symptoms may fluctuate in intensity over time.
How is it diagnosed?
Diagnosis typically involves a combination of:
Medical history and physical exam: Discussion of symptoms and a physical assessment.
Ultrasound: To visualize the kidneys and ureters and detect hydronephrosis.
Nuclear renal scan (MAG3 or DTPA scan): To assess kidney function and urine drainage. This is the most common diagnostic test.
Intravenous pyelogram (IVP): An X-ray using contrast dye to visualize the urinary tract. (Less commonly used now with advancements in other imaging).
CT scan or MRI: May be used to further evaluate the anatomy and rule out other causes of obstruction.
Urinalysis: To check for infection or blood in the urine.
Timeline of Symptoms
The timeline of symptoms can vary greatly.
Prenatal: Detected during routine prenatal ultrasounds as hydronephrosis.
Infancy/Childhood: Symptoms may appear early in life, such as failure to thrive, UTIs, or abdominal mass.
Adulthood: Some individuals may not experience symptoms until adulthood, when flank pain, kidney stones, or UTIs develop.
Symptoms might be intermittent initially and then worsen over time if the obstruction is severe and untreated.
Important Considerations
Early diagnosis and treatment are crucial to prevent permanent kidney damage.
Treatment options range from observation (for mild cases) to surgical correction (pyeloplasty, either open, laparoscopic, or robotic) for more severe cases.
Regular follow-up with a urologist or nephrologist is essential to monitor kidney function and ensure treatment effectiveness.
Hydration is important, but excessively forcing fluids is not recommended, as it can exacerbate pain.
In some cases, the obstruction may resolve spontaneously, particularly in infants.
Surgery is generally very effective at correcting UPJ obstruction.