Extreme unilateral hydronephrosis with normal glomerular filtration rate: physiological studies in a case of obstructive uropathy

Abstract

A 30-year-old man presented with massive left hydronephrosis caused by congenital stricture of the ureteropelvic junction. Glomerular filtration rate of the post-released kidney (inulin clearance and creatinine clearance) was preserved completely. Simultaneous individual kidney function tests showed the following values expressed as the ratio of post-obstructed to normal kidney: inulin clearance 142 per cent, urine flow rate 475 per cent, sodium clearance 221 per cent and urinary excretion of prostaglandin E2 617 per cent. Urinary osmolality was 257 and 791 mOsm./kg. in the obstructed and normal kidneys, respectively. Administration of indomethacin, a cyclo-oxygenase inhibitor, caused decreased urinary excretion of prostaglandin E2 in both kidneys, with drastic antinatriuresis manifested predominantly in the normal kidney. We conclude that the glomerular filtration rate may be preserved despite huge hydronephrosis, which suggests that the human kidney is salvageable even after a prolonged period of unilateral ureteral obstruction, and the contralateral normal kidney mitigates the volume losses from the obstructed kidney.