A 45 years obese lady presented with pain in the left flank. A USG KUB was done promptly which was suggestive of Left Severe Hydro Nephrosis and a 2 cm calculus at the Pelvi-Ureteric Junction. The patient was further investigated by CT Scan.

Plain CT KUB Thinned out Kidney with Calculus	CT KUB with Contrast Thinned out Parenchyma not showing enhancement
She was investigated further by DTPA Scan which did not show any residual function of Left Kidney. Laparoscopic Nephrectomy was performed successfully and she was discharged on Day 3.
Nephrectomy Specimen	Post Op Day 2

Discussion: This was a case of Pelvic-Uretric Junction Obstruction presenting as non functioning kidney and a secondary renal calculus. PUJO can be asymptomatic or can lead to Flank Pain, UTI, Pyelonephritis, and Secondary Calculus. Any Hydronephrosis with or without stone in a child needs to be investigated early to identify this condition.

Treatment is Pyeloplasty. Laparoscopic Pyeloplasty is the standard of care in adults as well as in selected children. Delayed identification of this condition at a stage where the kidney is no longer functioning needs Nephrectomy to prevent recurrent Pain, Infection and Hypertension due to Scarring.