Introduction:

The ureteropelvic junction obstruction syndrome is more frequent at paediatric ages. It consists of a urinary tract obstruction that results from a partial or total intermittent blockage of the urine flow at the ureteropelvic junction. It is the most common cause of hydronephrosis in the prenatal period and, for young adults (18 to 24 years old), the hospitalization rate for this cause was 0.7 per 100,000 in 2000, in the United States of America.

Case description:

A 21-year-old man, without any relevant past medical or familial history, resorted to the emergency department following pain referred to the left flank and haematuria that started on the same day. There, he was treated symptomatically and was discharged for ambulatory assessment of renal calculi by his family practitioner. Three days later, he scheduled a consultation in his primary care unit. The assessment of the patient was that he maintained the symptoms he had previously, as well as a bilateral absence of costovertebral angle tenderness and an abdominal mass, approximately 15 by 20cm in size, elastic in consistency and located in both left abdominal quadrants. With such findings, he was again referred to the emergency department for urgent revaluation. There, a computed tomography scan of the urologic system was taken, revealing extensive hydronephrosis that substituted the left kidney, without apparent obstruction, in accordance with the diagnosis of ureteropelvic junction obstruction syndrome. The patient was hospitalized for ureteral catheterization and left renal function evaluation.

Commentary:

In the presence of unilateral flank pain with haematuria it raises the suspicion for renal calculi. However, other causes should not be unaddressed, mainly in the presence of less typical presentations of disease. This clinical case reinforces the notion that this paediatric condition can be diagnosed in adult patients, but it is infrequent. In this case, the careful physical evaluation and validation of the patient’s complaints by the family practitioner were key aspects for an adequate orientation.

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