Editing Ureteropelvic Junction Obstruction (section)

==Diagnosis and Evaluation==
===History and Physical Exam===
*'''History'''
**'''<span style="color:#ff0000">Signs and Symptoms</span>'''[https://www.ncbi.nlm.nih.gov/books/NBK560740/ §]
**#'''<span style="color:#ff0000">Periodic abdominal pain (loin pain), usually after diuresis'''
**#'''<span style="color:#ff0000">Vomiting'''
**#'''<span style="color:#ff0000">Recurrent pyelonephritis'''
**#'''<span style="color:#ff0000">Fever'''
**#'''<span style="color:#ff0000">Uncommonly, abdominal mass, or hematuria secondary to infection'''
===Labs===

* '''Serum creatinine'''
** Assess of baseline renal function

===Imaging===

* Performed to determine the anatomic site and functional significance of an apparent obstruction

==== Contrast-enhanced axial imaging ====
*'''CT/MR urography'''

==== Nuclear diuretic renography ====
*'''Commonly used''' for diagnosing both UPJ and ureteral obstruction
*'''<span style="color:#ff0000">Most commonly used agent in renogram studies is technetium 99m mercaptoacetyltriglycine (99m Tc-MAG3), especially in the pediatric population[https://www.ncbi.nlm.nih.gov/books/NBK560740/ §]'''
**In the adult population, other agents can be used, such as diethylenetriamine pentaacetate (DTPA)
*'''<span style="color:#ff0000">Provides quantitative data regarding differential renal function and obstruction</span>''', even in hydronephrotic renal units '''(see Pathophysiology of UUT Obstruction Chapter Notes for nuclear imaging details)'''
**'''<span style="color:#ff0000">In general, kidneys with < 15% differential function are nonsalvageable in adults</span>''' (Chapter 48 suggests <10%)'''.'''
***'''If the potential for salvageability of function is still unclear, an internal stent or percutaneous nephrostomy may be placed for temporary relief of obstruction and renal function studies subsequently repeated'''