RENAL STONES

Management of Renal Stones in Pregnancy



Management of Renal Stones in Pregnancy

Introduction

The most common cause of non obstetrical pain is the Urolithiasis, and it may require pregnant patients to hospitalize. The rate of reoccurring calculi in pregnant women is 1:1500. This ratio is small and is equal to the patients that are not pregnant. Symptomatic stones are usually found in the ureter and renal pelvis, and they both affect the ureters with the same frequency. After first trimester, eight to nine percent are found diagnosed. Dealing with Urolithiasis in pregnancy is a challenge from many ways in diagnostic and therapeutic (Drago, et al 1982, p. 578).

The first reason is the adverse effects of anesthesia surgery and radiation can create many complications in treatment. Another reason is that the signs of Urolithiasis is also found in normal pregnancy or may be related to other abdominal diseases. According to the study of Stothers and Lee (1992) it is found that appendicitis, placental abruption and diverticulitis are the most common mistaken diagnosed in 28% of the patients. Most of the stones are passed instinctively with the help of conservative treatment. If the stones are not passed than they might create many problems like intractable pain, initiate premature labor, urosepsis can also occur or interfere in the normal labor procedures.

For Urolithiasis in pregnant patients, renal ultrasonography is the first line screening test. Other tests like CT scanning and intravenous pyelography are used for special cases. In first and second trimester, no ionizing radiation is used. MRI is only used for urinary stone diseases. There is a whole range of treatment for stones in pregnancy. The range includes conservative management like hydration, bed rest and analgesia, invasive measures like percutaneous nephrostomy, stent placement, ureteroscopy with stone manipulation. The appropriate diagnosis and management is used which is beneficial for both mother and baby (Srirangam, et al 2008, p. 867).

Prophylaxis

The best cure for Urolithiasis is prevention. Many studies suggest various preventions for Urolithiasis in pregnant patients. The studies suggest the treatment of women who are planning pregnancy can be done with prophylactic asymptomatic caliceal stones. Some studies suggest metabolic evaluation dir former stones and prophylactic treatment for before pregnancy. It is recommended that those women who desire pregnancy with cystinuria must take genetic counseling and management for their disease before the start of pregnancy (Semins, et al 2009, p. 139).

Pathophysiology

The physio anatomical changes that occur in pregnancy facilitate hydronephrosis and stone formation. The gravid uterus compresses on the right ureter since the second trimester of pregnancy and a physiological hydronephrosis can be seen in 90% of women. High levels of circulating progesterone and decreased ureteric peristalsis along with increased urinary calcium excretion facilitate stone formation. This is negated by increased circulatory volume and excretion of Urolithiasis inhibitors such as citrate and magnesium as seen in women with no stone formation. A research published by Burgess and colleagues from Minnesota found a high percentage of calcium phosphate stones but a much lower successful spontaneous passage rate of 48% ...