1011Vol. 10    |    No. 3    |    Summer 2013    |U R O LO G Y   J O U R N A L

Lower Moiety Pelvi Ureteric Junction 
Obstruction Leading to Acute Renal Failure 
in an Ectopic Fused Kidney
Priyadarshi Ranjan, Ranjana Singh, Aneesh Srivastava

Keywords: Ureteral Obstruction; etiology; surgery; Kidney abnormalities; acute renal fail-

ure

INTRODUCTION

Uretero-Pelvic Junction Obstruction (UPJO) has many etiologies and remains a rare cause of renal failure. We present a rare case of fused kidney causing pelvi-ureteric junction obstruction and acute renal failure.
CASE REPORT
A 37 years old man presented to the emergency department with oliguric renal failure. At 

presentation his serum creatinine was 12 mg/dl and he was in septicemia. He had passed 

only 250 ml of urine in the past 24 hours. Abdominal sonography revealed right fused renal 

mass with hydronephrosis of both the upper and the lower moieties. An abdominal computed 

tomography (CT) scan revealed grossly destroyed parenchyma of the lower moiety with 

preserved parenchyma but gross hydronephrosis of the upper moiety (Figure 1). After sta-

bilization bilateral percutaneous nephrostomies were placed in both the moieties. The upper 

moiety drained around 3 liters per day, while the lower moiety did not show urine produc-

Corresponding Author: 

Priyadarshi Ranjan, MD
Consulatant Urologist and Cheif 
Kidney Transplant Surgeon, Fortis 
Hospital, Mohali, Punjab, India.

Tel: +91 800 440 0008
Email: priydarshiranjan@sify.com

Received June 2011
Accepted September 2011

CASE  REPORT



1012 |

tion. Subsequent nephrostograms revealed pelvi ureteric 

junction (PUJ) obstruction in the lower moiety with normal 

drainage of the upper moiety. A review CT and Magnetic 

Resonance Imaging (MRI) revealed the cause of obstruc-

tion of the lower moiety at the level of the PUJ which sub-

sequently lead to the concomitant obstruction of the upper 

moiety (Figure 2). In view of negligible renal function of 

the lower moiety, lower polar heminephrectomy was done. 
(1,2) The upper moiety compression was relieved and did not 

require any intervention. The patient had uneventful recov-

ery with normal renal function at discharge. 

CONFLICT OF INTEREST
None declared.

Figure 1. CT Scan and MRI demonstrating the grossly hydrone-
phrotic parenchyma of the lower pole due to PUJ obstruction. 
The upper polar ureter emerging laterally marked with arrow 
can be seen getting compressed due to the compression by the 
lower moiety.

Figure 2. A triphasic CT reconstruction demonstrating both the 
upper and lower moiety nephrostomies and the normal ureter of 
the upper moiety marked with an arrow.

Case  Report

REFERENCES

1. Ulchaker J, Ross J, Alexander F, Kay R. The spectrum of uret-
eropelvic junction obstructions occurring in duplicated col-
lecting systems. J Pediatr Surg. 1996;3:1221-4.

2. Horst M, Smith GH. Pelvi-ureteric junction obstruction in du-
plex kidneys. BJU Int. 2008;101:1580-4.