A study on diagnosis and management of urinary calculi in pregnancy

ABSTRACT

Background: Acute renal colic during pregnancy is associated with significant potential risks to both mother and fetus. Diagnosis is often challenging because good imaging options without radiation use are limited. Management of diagnosed nephrolithiasis is unique in the pregnant population and requires multi-disciplinary care. Aim: To study the metabolic alterations during pregnancy that may promote kidney stone formation, the complications associated with acute renal colic in the pregnant state, and our proposed diagnostic and management algorithms when dealing with this clinical scenario. Materials and methods: This observational study was done in 2017-2018 at, Department Of Urogynecology, Institute of Social Obstetrics, Government Kasturba Gandhi Hospital, Chennai. Totally 22 pregnant women were included in the study. Charts of the patients were retrospectively reviewed and observations included age, presenting symptoms, diagnostic methods, urologic intervention, calculi location, stone size, trimester of diagnosis, and postpartum treatment. Results: The diagnosis of urolithiasis was two (11.1%) in the first trimester, six (33.3%) in the second trimester, and 10 women (55.5%) in the third trimester. Of the 20 stones, nine were on the right side and 11 were on the left; two patients had bilateral urinary stones detected. Flank pain was the most common clinical presentation in 17 women, gross hematuria in five, fever in four, and urinary frequency in one patient. In laboratory tests, microscopic hematuria was found in 10 cases, pyuria in six, and leukocytosis (leukocyte cell count > 10,000/mm3 ) in five. Diagnostic imaging was based on the transabdominal US. In 14 cases, renal or ureteral stones were detected by the US. The other four patients had hydronephrosis on the US without definite detection of the ureteralstones. Conclusion: Women, in general, appear to be developing urolithiasis with increasing frequency. Consequently, it is expected that the incidence of pregnant women with stones may also increase. A T. Srikala Prasad. A study on diagnosis and management of urinary calculi in pregnancy. IAIM, 2019; 6(3) 248-252. Page 249 diagnostic and therapeutic approach that takes into account the individual patient’s symptoms, stage of pregnancy and stone characteristics should be the intent in each case.