A Child with Bilateral Hydronephrosis Presenting with Coexistence of Bilateral UPJ and Bilateral UVJ Obstruction: A Case report

Introduction: Hydronephrosis can be either unilateral or bilat- eral, often due to ureteropelvic junction (UPJ) or ureterovescial junction (UVJ) obstruction. UPJ and UVJ can coexist in the same ureter, varying in severity, and the presence of both can make appropriate diagnosis more difficult. As far as we know, there are no reports of concurrent bilateral UPJ and bilateral UVJ obstructions. Case Presentation: An 11 month old female with history of congenital hydronephrosis and urethral stenosis presented to the hospital with Klebsiella urosepsis and acute kidney injury. Due to bilateral hydroureteronephrosis, thickened bladder wall, and failed catheterization attempt, a suprapubic catheter was placed to relieve bladder outlet obstruction. However, minimal decompression was observed and the serum creatinine con- tinued to rise to 1.9 mg/dL despite therapy. A MAG-3 scan showed bilateral high-grade UVJ obstruction, for which she underwent bilateral nephrostomy tube placement. With renal decompression, the serum creatinine trended downwards to her new baseline of 0.6 mg/dL. Subsequently, she underwent bilat- eral ureteral re-implantation at 13 months of age. A repeat ante- gradenephrostogram revealed bilateral UPJ obstruction as well. Conclusion: It is important to have a high index of suspicion for coexisting UPJ and UVJ obstruction when evaluating a patient with hydronephrosis. The aim for therapy is to salvage the kidney function. A multi-disciplinary approach with a nephrologist and urologist is also crucial.