Management of Kidney Stone Disease in Pregnancy: A Practical and Evidence-Based Approach

Abstract

Purpose of Review Suspected kidney stone disease during pregnancy is a difficult condition for health professionals to manage. This is partly due to the more limited range of diagnostic and therapeutic strategies, which can be safely applied. A comprehensive review of literature was performed to identify evidence to develop a practical guide to aid clinicians. Recent Findings Ultrasound remains the recommended first line option for imaging. Complicated cases, such as suspected infected obstructed system, require urgent decompression such as in the form of percutaneous nephrostomy. This article highlights the pharmacotherapeutic agents, which are considered safe for use in pregnancy. Where surgical intervention is indicated, evidence supports ureteroscopy to be a safe option as long as infection has been treated. Ureteroscopy can offer definitive clearance of the stone(s) and can be less burdensome regarding bothersome symptoms compared to indwelling ureteral stent or nephrostomy, which also require regular exchange due to the high propensity for encrustation in pregnancy. Summary A multidisciplinary approach is fundamental to safely manage suspected kidney stone disease in pregnancy. Adoption of a locally agreed pathway as suggested in this article supports improved patient care.

Ureteroscopy during pregnancy under local anesthesia and light sedation: Technique and video

“…Management of suspected urolithiasis in pregnancy and the shared decision for URS should be part of a multidisciplinary assessment, as described previously by our center. [ 3 ] Patients with persistent pain due to suspected urolithiasis, which is refractory to analgesia and has an observation period of 48 hours, are candidates for primary URS. When using this anesthetic approach, URS can be performed in any trimester.…”

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part II: Non-Obstetric Complications

“…Renal colic represents severe pain associated with obstructive hydronephrosis, most often caused by a kidney stone; it is the leading non-obstetric cause of abdominal pain and subsequent hospital admission during pregnancy [ 71 ]. The incidence of a symptomatic stone event is relatively rare, occurring in about 1 in 2000 pregnancies, and similar to the childbearing non-pregnant population [ 72 , 73 ].…”

“…Ureteral obstruction may lead to significant maternal morbidity, including pyonephrosis, urosepsis, preterm labor, cesarean delivery, hypertensive disorders and gestational diabetes; these potential complications make timely and accurate diagnosis crucial so that proper management can be initiated for the health of the pregnant patient and the foetus [ 71 ].…”

GRHPR gene variations in Iraqi patients infected with calcium oxalate kidney stones

“…The disease is quite complex and has several possible etiologies 17 including sex, age, race 18 , pregnancy 19 , diabetes and hypertension 20,21 , high temperature degrees 22 , nutrition regime 23 like depending on animal protein-rich diet and consuming foods that contain high amounts of oxalates, Vitamin C and D deficiency and salt intake with low potassium and low citrate content in the nutrition are main factors that lead to stones formation [23][24][25][26][27][28] and insufficient drinking water intake 29,30 Also, biofilm forming microorganisms have a role in stone forming; including Pseudomonas spp., Klebsiella spp., Proteus spp., Oxalobacter formigenes play a role in calcium oxalate formation and other certain bacterial species [30][31][32] . Some drugs have a potential role in promoting kidney stone formation like nephrocalcin, osteopontin, urinary prothrombin fragment-1, bikunin and glycosaminoglycans 33 .…”