Urinary Tract Obstruction Quiz

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Which statement best describes pelviureteric junction (PUJ) obstruction?

A A congenital narrowing of the vesicoureteric junction causing ipsilateral hydronephrosis
B A congenital abnormality of ureteric peristalsis that causes reflux of urine into the kidney
C Usually congenital impairment of urine drainage from the renal pelvis into the proximal ureter ✓
D An acquired narrowing of the pelviureteric junction caused by recurrent urinary tract infections in adulthood
E An acquired obstruction of the pelviureteric junction by a renal calculus

The answer is C: Usually congenital impairment of urine drainage from the renal pelvis into the proximal ureter

Explanation

Why C is correct

See Pelviureteric Junction Obstruction. Option C is correct: pelviureteric junction (PUJ) obstruction is usually a congenital impairment of drainage at the junction between the renal pelvis (the funnel-shaped space where the kidney collects urine) and the proximal ureter (the first part of the tube leading to the bladder). Urine cannot leave the kidney freely, so it builds up in the renal pelvis and the collecting system dilates, which is called hydronephrosis. The narrowing is present from birth, so it is often detected as urinary tract dilatation before birth. It is one of the most common causes of hydronephrosis in children, and the obstruction is at the top of the ureter, which distinguishes it from bladder outlet obstruction below. Most cases can be managed conservatively with follow-up and serial imaging, and surgical repair is needed if kidney function deteriorates or if there are infections or symptoms. Memory aid: PUJ is the Pelvis-to-Ureter Junction, at the top of the ureter.

Site: the junction between the renal pelvis and the proximal ureter.
Cause: usually a congenital impairment of drainage.
Result: urine builds up in the renal pelvis and the collecting system dilates (hydronephrosis).

Why the other options are incorrect

A. A congenital narrowing of the vesicoureteric junction causing ipsilateral hydronephrosis: This places the congenital narrowing at the vesicoureteric junction, where the ureter enters the bladder, rather than at the pelviureteric junction.
B. A congenital abnormality of ureteric peristalsis that causes reflux of urine into the kidney: This describes vesicoureteric reflux, where urine flows backwards into the kidney, not obstruction of drainage at the pelviureteric junction.
D. An acquired narrowing of the pelviureteric junction caused by recurrent urinary tract infections in adulthood: Recurrent urinary infection is not the usual cause. Pelviureteric junction obstruction is typically developmental, and the narrowing is present from birth rather than acquired after infection.
E. An acquired obstruction of the pelviureteric junction by a renal calculus: A stone at the pelviureteric junction can obstruct urine flow, but this is secondary stone obstruction rather than the congenital pelviureteric junction obstruction the term usually describes.

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1
Which of the following best describes obstructive uropathy?
2
A patient with known urinary tract obstruction becomes febrile, tachycardic and hypotensive, with flank pain and raised inflammatory markers. Which feature most strongly distinguishes pyonephrosis from uncomplicated hydronephrosis?

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