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Congenital obstructive nephropathy: is the fog lifting?

Renal obstruction is well recognized as causing renal dysfunction and can be reliably repaired, so why is there still a fuss about UPJ obstruction sufficient to prompt many laboratories, particularly Dr. Chevalier's, to invest significant time and effort in trying to define this common entity1? The crux of this issue involves the many neonates with renal dilation, usually detected prenatally, who have no obvious clinical problems and seem to grow and thrive. While we know that some might have demonstrable deterioration of renal function over time, we clearly do not know who these children may be. The controversy regarding congenital obstructive uropathy remains lively and shows no sign of being readily resolved2. Two camps have emerged in the ongoing debate, the "watchers" and the "fixers." The "watcher" assumes that the incidence of renal functional deterioration can be accurately measured, promptly detected, and corrected with specific intervention in these children3, 4. The "fixer" feels that renal deterioration is slowly ongoing, inaccurately measured, and by the time intervention is undertaken, may be irreversible to some degree. These different perspectives seem to follow some cultural and institutional lines, but are often quite unpredictable. This paper attempts to shed further light on this murky debate.