Ureteropelvic junction obstruction: three clinical cases with first symptoms during adolescence

  • Mariana C. Abreu Pediatrics Department, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • Alexandra Pinto Pediatrics Department, Centro Hospitalar Lisboa Norte
  • Claudia Aguiar Pediatrics Department, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João
  • Ribeiro de Castro Urology Department, Centro Hospitalar Universitário do Porto
  • Célia Madalena Pediatrics Department, Centro Hospitalar Póvoa de Varzim - Vila do Conde
Keywords: adolescence, hydronephrosis, ureteral obstruction

Abstract

Ureteropelvic junction obstruction (UPJO) is defined as urine flow blockage occurring where the ureter enters the kidney and is presented as urinary tract dilatation (UTD), formerly named hydronephrosis. The condition may be congenital or acquired. Most UTD are diagnosed by antenatal ultrasonography, but some cases present later. In adolescence, clinical manifestations include intermittent flank or abdominal pain, hematuria, nephrolithiasis, urinary tract infection, deterioration of renal function, or arterial hypertension. The imaging modality of choice to diagnose UTD is ultrasonography (US). A diuretic renography will allow to identify UPJO. Treatment goals are to prevent renal function deterioration and relieve symptoms. Although conservative treatment measures are favored, some patients require surgical correction (pyeloplasty). Three clinical cases with first symptom onset during adolescence are presented. The first case is a 14-year-old boy with abdominal pain suspected to correspond to acute appendicitis; the second case is a healthy 15-year-old female which presented with dysuria and lumbar pain; the third case is a 15-year-old female with prenatal diagnosis of left ureteropelvic dilation but no further medical problems, with left lumbar pain, dysuria, and fever.
Conclusion: A high degree of suspicion is required to include UPJO in the differential diagnosis of flank or back pain in adolescents.

Author Biography

Mariana C. Abreu, Pediatrics Department, Centro Materno Pediátrico, Centro Hospitalar Universitário de São João

Serviço de Pediatria, Hospital Pediátrico Integrado do Porto, Centro Hospitalar de São João

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Published
2019-04-11
Section
Case Reports