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One of the interesting clinical scenarios that the USMLE may mention in a question stem is the adolescent who has had his first "binge" drinking party or in camping and suddenly develops severe flank pain and his renal function starts to deteriorate.

He has never experienced urinary symptoms before and this is the first time to get such symptom.

The trick here is that this patient is having congenital Ureteropelvic junction obstruction UPJ where urine was passing without problems when it's in normal amounts and flow rate but once the patient is having his first episode of "diuresis" the obstruction hold up the urine and a back pressure builds up back on the kidney.
 

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Well said. Great explanation.

One of the interesting clinical scenarios that the USMLE may mention in a question stem is the adolescent who has had his first "binge" drinking party or in camping and suddenly develops severe flank pain and his renal function starts to deteriorate.

He has never experienced urinary symptoms before and this is the first time to get such symptom.

The trick here is that this patient is having congenital Ureteropelvic junction obstruction UPJ where urine was passing without problems when it's in normal amounts and flow rate but once the patient is having his first episode of "diuresis" the obstruction hold up the urine and a back pressure builds up back on the kidney.
 
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