Congenital renal disorders Quiz: Ace Your Exams

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A 25-year-old female comes to the primary care PA for a follow-up appointment. The patient is currently asymptomatic and denies increased urinary frequency or dysuria. However, she has had multiple urinary tract infections during the past year, each of which resolved with antibiotic therapy. Additionally, the patient has had 3 episodes of calcium oxalate nephrolithiasis treated with conservative measures. She is sexually active, in a monogamous relationship, and uses condoms consistently. Temperature is 37.0°C (98.6°F), pulse is 65/min, and blood pressure is 120/80 mmHg. Physical examination shows no abnormalities. Urinalysis and IV pyelography are obtained and the results are shown below:  

 Urine   Reference range 
 Color  Yellow  Yellow 
 Clarity  Clear  Clear 
 Erythrocytes  8/hpf  0-4/hpf 
 Leukocytes  2/hpf  0-5/hpf 
 pH   5.5  4.6-8 
 Nitrates  Negative  Negative 
 Glucose   Negative  Negative 
 Protein  Negative  Negative 
 Bacteria   None  None 
 Sediment   None  None 
 An X-ray shows the lumbar spine and pelvis, with kidneys and ureters visible. Contrast material fills renal collecting systems and ureters, showing their anatomy.
Imager eproduced from Radiopedia

 Which of the following is the most likely underlying cause of this patient condition?

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