Profile and Outcome of Pelviureteric Junction Obstruction

Abstract

Obstructive uropathy represents one of the largest fractions of identifiable causes of renal failure in pediatric populations. This is one of the largest series of PUJ obstructions reported in children. PUJ obstruction is a relatively common congenital anamolyes in neonates and children and a cause of ESRD in developing countries. This series expands our knowledge about the clinical presentation and course of this disease. Pelviureteric junction (PUJ) obstruction is a partial or total blockage of the flow of urine that occurs where the ureter enters the kidney and is the most common cause of significant dilatation of the collecting system in the fetal kidney. We retrospectively analyzed children diagnosed as PUJ obstruction between the periods of 2008-2010 who presented to our institute. Forty four children were diagnosed to have PUJ obstruction. The median age at presentation was 11 months, with range of 3 months to 11 years. Male children constituted 34 (77.3%) cases. Unilateral PUJ with left sided involvement was more common (52.3%). Antenatal diagnosis was made in 18 (40.9%) cases. The common clinical presentations were fever, urinary tract infection (UTI) and abdominal pain. Hypertension was present in five (11.3%) patients and renal failure at presentation was seen in eight (18.2%) patients. Associated urogenital anomalies were present in twelve (27.3%) patients, with medullary cystic kidney disease (MCKD) being the most commonassociated anomaly. Prophylactic antibiotics were not prescribed to patients. Urinary tract infection was present in fourteen (31.9%) patients with E. coli being the most common organism (75%). Conservative management with regular follow up was done for 32 patients and the remaining twelve patients underwent pyeloplastyin view of gross hydronephrosis, and four (33.3%)of these patients later underwent nephrectomy for a non-functioning kidney. Antenatal screening is mandatory to make an early diagnosis and for further management and close follow upof PUJ obstruction. Randomized control trials and longer follow up studies are needed for evidence to suggest the optimal management.