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Why am I still having hydronephrosis?

Q: I am a 28 years old student who underwent pyeloplasty (right-side) surgery four years back. Then I had a renogram after a year, which showed that the passage was clear. But due to long time inactivity I have lost some kidney function. GFR was 66 after one year of surgery. The sonogram indicated that the kidney was still enlarged. Why am I still having hydronephrosis? I feel tired sometimes as my heart rate also fluctuates in the lower part. My heart rate changes from 46-58.

A:Pyeloplasty is performed for management of upper urinary tract obstruction, specifically for congenital ureteropelvic junction (UPJ) obstruction which may not become apparent until middle age in some patients. In this context, it is important to rule out other causes of urinary tract obstruction. When obstruction is long standing, kidney function gets impaired and it may not improve even after after the obstruction is relieved. This is probably the reason why your GFR is still subnormal. Although Pyeloplasty is succesful in general, 5-10% of patients will have recurrent obstruction. For your current GFR of 66, you should not have problems with heart rate you are experiencing. Please follow up with your physician about this.

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