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Ureteropelvic junction obstruction is characterized by the obstruction of urine flow at the passage between the kidney and the ureter, and in cases of long-term obstruction, it is a clinical condition that may be associated with decreased kidney function and indirectly with growth and developmental delay.
Ureteropelvic junction obstruction associated with chronic hydronephrosis and loss of kidney function may contribute to slowed somatic growth and cause systemic effects by affecting fluid-electrolyte balance and metabolic processes when not adequately treated during childhood.
Ureteropelvic junction obstruction seen together with nutritional disorders and recurrent urinary tract infections in pediatric patients is associated with indirect pathophysiological mechanisms that increase the risk of developmental delay due to disruption of energy balance and the burden of chronic disease.
Ureteropelvic junction obstruction, whose prognosis improves with early diagnosis and surgical intervention, may cause delay in growth parameters in addition to loss of renal function when not managed in time; therefore, multidisciplinary follow-up and regular developmental assessment are important.
Do Impairments in Kidney Functions Lead to Growth Retardation?
The kidneys undertake vital functions such as maintaining the body’s fluid-electrolyte balance, filtering harmful substances, and regulating certain hormones necessary for bone development. Impairments in kidney functions during childhood have direct effects on growth and development.
When the kidney’s filtering function weakens, toxic substances such as urea and creatinine begin to accumulate in the blood. The increase in these substances causes decreased appetite, nausea, and general weakness in children. In a child who cannot be adequately nourished, weight gain slows, energy decreases, and height growth falls behind. Especially in chronic kidney diseases, serious regressions may be seen in the growth curve.
The kidneys also play a role in vitamin D activation and calcium-phosphorus balance. When this balance is disrupted, mineralization in the bones is not sufficient. Bone pain, deformities, and slow bone development occur in children. Height growth may be interrupted and puberty may be delayed.
Disruptions in hormone balance also affect growth. The erythropoietin hormone secreted by the kidneys stimulates the production of red blood cells. When kidney functions are impaired, the decrease in this hormone leads to anemia. Anemia reduces oxygen transport to tissues, lowering children’s energy and growth capacity.
Effects of Chronic Urine Accumulation on Body Development
In structural disorders such as ureteropelvic junction obstruction, urine cannot be fully drained from the kidney to the bladder. This condition creates permanent pressure in the kidney and chronic urine accumulation develops. Chronic urine accumulation not only damages kidney tissue but also negatively affects children’s general body development.
When there is constant pressure in the kidney, the filtering function weakens and toxic substances accumulate in the blood. Weakness, loss of appetite, and loss of energy occur in children. This condition may lead to slowed growth rate, reduced weight gain, and delay in height growth. Especially in long-term urine accumulation, developmental curves fall behind.
Chronic urine accumulation also prepares the ground for frequently recurring urinary tract infections. Children who have infections experience high fever, weakness, and fatigue. During this process, appetite decreases and children cannot be fed regularly. The growth process of children who frequently have infections is also negatively affected.
For children in the developmental age, regular functioning of the kidneys is critical not only for organ health but also for all metabolic processes. Chronic urine accumulation creates a chain effect on growth and development by disrupting energy balance, impairing eating patterns, and increasing the frequency of infections.
In the long term, this condition may lead to significant problems in both physical growth and children’s daily activities.
The Relationship Between Ureteropelvic Obstruction and Nutritional Problems
Ureteropelvic junction obstruction may also affect children’s eating patterns. Difficulty in urine flow increases kidney pressure, disrupts metabolic balances, and as a result, nutritional problems develop.
When kidney functions decrease, urea and creatinine accumulate in the blood. This condition causes loss of appetite, nausea, and reluctance to eat. In children who cannot be adequately nourished, weight gain slows and growth retardation begins. These effects become more pronounced especially during the rapid growth period.
Another cause of nutritional problems is frequently recurring infections. Urine remaining in the kidney due to ureteropelvic obstruction increases the risk of infection. Fever and weakness complaints in children with infections further reduce appetite. Recurrent infections disrupt eating patterns and negatively affect the child’s development.
The kidneys also function in calcium, phosphorus, and vitamin D metabolism. Disruption of these processes weakens bone health and slows bone development. When calcium taken from nutrition cannot be used sufficiently, growth rate decreases.
Nutritional problems seen in children with ureteropelvic junction obstruction are not limited only to loss of appetite and weight loss; they also create effects on bone health and the long-term growth process.
Is Ureteropelvic Obstruction More Common in Children with Developmental Delay?
The causes of developmental delay in children can be very different. Genetic factors, congenital anomalies, chronic diseases, and nutritional disorders are among them. Ureteropelvic junction obstruction is one of the most common congenital kidney diseases. This condition is a topic that should be examined more frequently in some children with developmental delay.
Ureteropelvic obstruction is a problem that can be noticed even on ultrasounds performed during pregnancy. After the baby is born, swelling and loss of function may also develop in the kidneys due to difficulty in urine flow. This impairment in kidney functions directly affects the child’s energy balance, nutrition, and growth. Therefore, investigating such kidney problems becomes important in children with developmental delay.
From the opposite perspective, developmental delay may occur in some children with ureteropelvic obstruction. However, ureteropelvic obstruction is not present in every case of developmental delay. Therefore, it is more accurate to evaluate the relationship between them as a condition seen together in some cases rather than a definite causality.
Studies show that children with chronic kidney problems grow more slowly and have lower weight gain compared to their normal peers. Since ureteropelvic obstruction is one of the important causes in this group, the possibility associated with developmental delay should not be ignored.
Is There a Connection Between Height and Weight Retardation and Ureteropelvic Obstruction?
Height and weight are among the most important indicators of child development. A healthy child eats regularly, uses energy efficiently, and follows growth curves. However, in children with ureteropelvic junction obstruction, this process sometimes does not progress as expected.
Since ureteropelvic obstruction makes the passage of urine from the kidney to the bladder difficult, it affects the working order of the kidneys. When the kidneys do not function properly, fluid and electrolyte balance in the body is disrupted. This disruption affects metabolism and prevents nutrients from being used efficiently enough. As a result, weight gain in children may slow and regression in growth curves may be seen.
In addition, when vitamin D and calcium metabolism, in which the kidneys play a role, is disrupted, bone development is negatively affected. This condition may cause height growth to progress more slowly than expected. Recurrent kidney infections also contribute to this picture; during infection periods, the child cannot be adequately nourished and experiences energy loss.
Studies show that children with chronic kidney disease may be shorter and have lower weight compared to their peers. Similar results may occur when ureteropelvic obstruction negatively affects kidney functions. However, this may not be equally evident in every child; in some children, development proceeds close to normal, while in others, delay is observed more clearly.
Possible Relationships Between Psychomotor Development and Kidney Diseases
Psychomotor development includes both the mental and physical skills of children. Many areas such as speech, walking, fine motor skills, learning capacity, and social interaction are evaluated under this heading. General health and energy balance of the body are critically important for healthy psychomotor development.
Kidney diseases such as ureteropelvic junction obstruction may indirectly affect this developmental process. When the kidneys cannot fully perform their function, weakness, loss of appetite, sleep disorders, and frequent infections may occur in children. These factors may negatively affect the child’s participation in games, mobility, and learning process.
Metabolic imbalances that occur due to kidney diseases may also make psychomotor development difficult. For example, electrolyte disorders may prevent muscles from working normally, which may slow both gross motor skills (walking, running) and fine motor skills (holding a pencil, buttoning).
In addition, children with chronic health problems may have fewer opportunities for social interaction compared to their peers due to hospital check-ups and treatments. This may lead to delays in social development and communication skills.
Although kidney disease is not always sought in children experiencing psychomotor developmental delay, chronic kidney problems such as ureteropelvic obstruction may be considered one of the factors that can contribute to this condition.
Does Early Diagnosis of Ureteropelvic Obstruction Prevent Developmental Delay?
Ureteropelvic junction obstruction may occur as a congenital problem and can be detected in some babies even during ultrasound examinations performed in the womb. Early diagnosis of this condition is important both for preserving kidney functions and supporting the child’s healthy development.
Accumulation of urine in the kidneys may damage tissues over time and lead to loss of function. In the long term, this condition may contribute to nutritional deficiencies and developmental delay by disrupting fluid-electrolyte balance. Directing children diagnosed early to treatment before this process begins helps prevent negative effects on growth
Early diagnosis also expands treatment options. While regular follow-up may be sufficient in cases that are small in size and have limited functional loss, surgical treatment can be planned at a more appropriate time in progressive cases. In this way, kidney function is preserved and the child can use the necessary energy and nutrient balance more healthily during the growth period.
In addition, ureteropelvic obstruction noticed in the early period prevents frequent infections and the indirect developmental problems they create. Correct interventions made before the disease progresses positively affect both the child’s physical growth and general development.
What Happens If Ureteropelvic Obstruction Is Not Treated?
When ureteropelvic junction obstruction is not treated, urine accumulation in the kidneys continues and may lead to permanent damage in kidney tissue over time. This condition may affect not only kidney health but also the child’s general developmental process.
When the obstruction in urine flow continues for a long time, kidney functions decrease. One of the functions of the kidneys is to maintain the body’s fluid and mineral balance. When this balance is disrupted, weakness, loss of appetite, slowed weight gain, and delay in height growth may be seen in children. In the long term, this condition may manifest as developmental delay.
Untreated ureteropelvic obstruction also leads to frequent urinary tract infections. Fever, loss of appetite, and decreased energy experienced during infections negatively affect children’s growth and activity level. Recurrent infections may also cause additional damage to kidney tissue.
Nutritional disorders are also among the long-term effects. In conditions where the kidneys do not function sufficiently, metabolic regulation is disrupted and the body cannot use the nutrients taken in efficiently. This negatively affects both weight gain and muscle and bone development.
Untreated ureteropelvic obstruction may lead not only to the risk of losing kidney functions but also to the child falling behind in the growth and development process.
How Is Ureteropelvic Junction Obstruction Treated?
The treatment of ureteropelvic junction obstruction is planned according to how advanced the obstruction is, the functional status of the kidney, and the age of the patient. In mild cases, only regular follow-up may be sufficient. However, surgical treatment is required in obstructions that seriously restrict urine flow and damage the kidney. Surgical options include open surgery, laparoscopic methods, robotic surgery, and some endoscopic interventions.
Open pyeloplasty is the classical method that has been used for many years. In this technique, the narrowed area between the kidney and the ureter is removed and the remaining parts are reconnected to provide urine passage. It is preferred in patients with advanced obstruction, those who have previously undergone unsuccessful surgery, or those with a complex structure. Although the recovery period is slightly longer because it requires a larger incision, the success rate is quite high and the probability of recurrence is low.
Laparoscopic pyeloplasty is a minimally invasive method frequently used today as an alternative to open surgery. The narrowed part is removed and repair is performed with a camera and instruments inserted through small incisions. It allows less pain, a shorter hospital stay, and rapid recovery. Its success rate is similar to open surgery.
Robotic pyeloplasty has become increasingly widespread in recent years. Thanks to robotic surgical systems, the surgeon can make more precise movements and work meticulously even in narrow spaces. This method is especially preferred in pediatric patients and recurrent obstructions. The recovery process is fast, tissue damage is lower, and it has a high success rate.
Endopyelotomy is an alternative approach. The obstruction area is cut and widened with the help of a laser or electrocautery by entering with an endoscope. Then, a stent is placed to keep the urinary tract open. Although the procedure time is short and it is less invasive, the probability of recurrence is higher compared to open or laparoscopic methods. Therefore, it is generally used in mild cases or in patients who are not suitable for surgery.
Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.
He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.
