Q: I am a 41 years old man who underwent a complete health check up four months back, the results were normal. However, the ultrasonogram of the abdomen showed: right moderate to gross hydroureteronephrosis ureteric stricture. CT/ KUB’s impression: right moderate dilatation of pelvicalyceal system seen with normal appearing right ureter, NPUJ calculi seen. Feature are of congenital PUJ obstruction. Contrast excretion is delayed. And, diuretic renal study (isotope scan) impression: reduced function of enlarged right kidney with obstruction to drainage from the pelvis. Good function of left kidney with no obstruction to drainage. The total glomerular filtration rate (GFR) - 109 ml/min, normal lower limit of GFR for age - 82 ml/min, relative renal function - left kidney - 55% (60 ml/min), right kidney - 45% (49 ml/min).

• Is the PUJ obstruction due to the calculi or is the calculi due to the PUJ obstruction?
• In the CT KUB report, it has been mentioned: Feature are of congenital PUJ obstruction. How do we exactly know that the problem exists since birth?
• Can the PUJ obstruction be rectified, if the calculi are removed?
• Is homeopathy treatment effective? Can it be taken side by side along with allopathic treatment?

A:Your history is suggestive of right sided obstruction of the urinary tract namely at the level of kidney and ureter meeting point (junction), which has resulted in the back pressure causing the swelling of right sided kidney-ureter called ‘hydroureteronephrosis’. Further, Renal scan reveals delayed function on the right kidney, a fall out of the back pressure from the obstruction. The obstruction could be either due to a stone which you may have passed subsequently or due to an underlying stricture at the mentioned site, often congenital, goes undetected before being diagnosed incidentally or due to the symptoms of pain and fever related to the urinary tract infection from the obstruction. Now as long as you are symptom free along with well preserved kidney function (GFR) as happens to be in your case, all you require is a follow up repeat ultrasound at a regular interval along with blood tests namely serum creatinine level to closely monitor your kidney size (watching for any worsening hydronephrosis) and function respectively. These monitoring are intended to detect any signs of progressive kidney injury. Surgical correction by a urologist would be mandated if kidney function gets worse or you become symptomatic from the underlying hydrouretero-nephrosis. Lastly, kidney stone can be a cause of transient obstruction resulting in the above findings. However, if you happen to pass stones on a recurrent fashion, you would need further blood and urine tests to ascertain the cause of your predisposition towards recurrent kidney stone formation. I am not aware of homeopathic medicine's role in the current condition of yours.