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Published on: October 12, 2017
Pelvi-Ureteric Junction Obstruction in a Solitary Functioning Kidney in Children: An Unfavourable Combination
Mathilde Grapin1, Lucas Rabaux2, Mathilde Glenisson2
1Department of Pediatric Nephrology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France, Reference Center for Inherited Renal Diseases (MARHEA), Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
Insights
Children with a solitary functioning kidney (SFK) and pelvi-ureteric junction obstruction (PUJO) have a high risk of chronic kidney disease (CKD). Neonatal acute kidney injury (AKI) further increases this risk in SFK/PUJO patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Renal Function Studies
Background:
- Solitary functioning kidney (SFK) in children is associated with chronic kidney disease (CKD).
- Congenital anomalies of the kidney and urinary tract (CAKUT) are common in SFK.
- Pelvi-ureteric junction obstruction (PUJO) is the most frequent obstructive uropathy in SFK.
Purpose of the Study:
- To evaluate long-term kidney function in children operated on for PUJO within an SFK context.
- To identify risk factors for CKD development in pediatric SFK patients with PUJO.
Main Methods:
- Retrospective cohort study of children with SFK.
- Subgroup analysis comparing SFK with operated PUJO, SFK without CAKUT, and SFK with other CAKUT.
- Assessment of CKD markers and measured glomerular filtration rate during follow-up.
Main Results:
- Children with SFK and PUJO showed a significantly higher proportion of CKD (43%) compared to SFK without CAKUT (12%).
- Neonatal acute kidney injury (AKI) was a significant predictor of subsequent CKD in the SFK/PUJO group (OR 4.8).
- Surgery for PUJO was indicated due to neonatal AKI or worsening renal pelvis dilation.
Conclusions:
- PUJO in SFK is linked to a high incidence of childhood CKD.
- The presence of neonatal AKI exacerbates the risk of CKD in pediatric SFK patients with PUJO.
- Long-term monitoring of kidney function is crucial for children with SFK and PUJO.
Aim:
Solitary functioning kidney (SFK) is linked to chronic kidney disease (CKD) in children, particularly when associated with congenital anomalies of the kidney and urinary tract (CAKUT). Pelvi-ureteric junction obstruction (PUJO) is the most frequent obstructive uropathy in SFK. This study aimed to evaluate long-term kidney function in children operated on for PUJO in an SFK.
Methods:
Among a retrospective cohort study of children with an SFK, a subgroup analysis was performed: primary SFK with operated PUJO (n = 35); primary SFK without CAKUT (n = 108); primary SFK with CAKUT other than PUJO (n = 24). Markers of CKD and measured glomerular filtration rate were assessed during follow-up.
Results:
Surgery was indicated because of neonatal acute kidney injury (AKI) (n = 21), worsening renal pelvis dilation (n = 10). The median age at surgery was 15 months (1.2-30 months). At a median age of 13 years at last follow-up, the proportion of CKD was higher in primary SFK with PUJO compared to primary SFK without CAKUT (43% vs. 12%, p = 0.0008). In SFK/PUJO, neonatal AKI was predictive of subsequent CKD (OR 4.8, p = 0.04).
Conclusion:
PUJO in an SFK is associated with a high rate of CKD during childhood, particularly when neonatal AKI is present.
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