Is it necessary to remove a non functioning hydronephrotic kidney?

Q: I am 43 years old and have hydronephrosis in the left kidney and ureter. The renal scan function test indicated that it is non-functional. My doctor suggested no operation because I have no pain, bleeding or infection. Shouldn't the obstruction causing the hydronephrosis be opened anyway? Is there a need to remove the kidney?

A:You have a non functioning hydronephrotic kidney. The usual indications for removal of a non-functioning kidney is usually incapacitating pain, uncontrolled bleeding on infection and therefore the advice is appropriate. If the kidney has more than 10-15% functioning and there is obstruction then obstruction should be opened and a trial for improvement of function of kidney can be attempted. However if the kidney has less than 10% function, then removing obstruction does not lead to any improvement in function and thus is not worthy of trial. As you are young, there is higher chance of this kidney getting infected in developing pain and it is likely that it may have to be removed.