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Friday, July 25, 2014
Asymptomatic UPJ Obstruction?
I have been diagnosed with a UPJ obstruction of R kidney. Have had CT with IV dye, retrograde pylogram + cystoscopy and renal nuclear scan which showed both kidneys still functioning well but T1/2 of 89 mins on RHS. I have been entirely asymptomatic. The UPJ was found incidentally on ultrasound. The surgeon is not inclined to operate at this point. How will I know if the condition worsens? ie what symptoms will I experience? I get muscular back pain from sports. How can I tell the difference between that + kidney pain? Will it be sudden/sharp or gradual ache? I am concerned because I know kidneys can sustain a lot of damage before you know something is wrong.
You are right, the kidneys can definitely sustain a great deal of damage before there are any symptoms at all. I am curious about why the surgeon is "not inclined to operate at this point." The degree of blockage in your right kidney sounds significant, since a normal T1/2 (the time for the kidney to excrete 50% of the radiotracer) is less than 10-12 minutes. I'm not sure what is meant by "functioning well" if the right kidney is taking so long to excrete the radiotracer agent.
In any case, if the obstruction worsens, the symptom to expect would be a dull, aching right flank pain in the area near the lower edge of the right ribs in the back. Some people report that the pain is especially worse if they drink beer (or a lot of liquid), since that causes urine output to increase rapidly, sometimes beyond the ability of the sluggish kidney to keep up. The kidney then will dilate and stretch, which causes pain. Initially, if the blockage is fixed so that urine can flow out freely, there is no permanent damage to the kidney. However, if it remains in a blocked and stretched state for weeks to months, it can be irreversibly damaged and eventually lose all function.
So you should have a frank discussion with your surgeon about why he/she does not feel any urgency to operate. If you feel that you cannot get a good answer, please do not hesitate to seek a second opinion. Normal people are blessed with much more kidney function than they actually need, so even if your right kidney were completely ruined, the left would end up doing about 1-1/2 times the work of a normal kidney, which would be plenty to keep you out of trouble. But it is not a good idea to waste a good kidney, especially if you are a young person and may need that function later in your life.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University