Kidney stones during Pregnancy

Did you realize that the most frequent reason for abdominal pain during pregnancy is kidney stones, also referred to as Urolithiasis? Although pregnancy-related rocks are unfamiliar, the correct and accurate diagnosis is crucial to ease the pain and prevent premature labor. Most stones are not large enough to pass through the urinary tract. However, more substantial stones need medical attention and therapy. Let’s examine all aspects of this disease, particularly during pregnancy.

Does kidney disease cause kidney stones?

Urinary stones result from the aggregation of chemicals that dissolve in urine. If the concentration of these chemicals reaches an optimum level, the crystals form and turn into rocks. 

What are the physiological changes that cause kidney stones in pregnant women?

Here is a brief overview of the physiological changes a pregnant woman experiences. The changes are usually seen in the second trimester and then diminish after the birth –

  • Specific changes in the woman’s body physiology during pregnancy could affect the urinary tract and lead to an increased risk of having issues with an existing kidney stone(s). These modifications may increase the likelihood of the creation of kidney stones.
  • In later pregnancy, the size and place of the uterus could limit urine flow. The ureters dilate during pregnancy and might not be able to eliminate urine as effectively, and this can cause an increase in hydronephrosis (swelling of kidneys). The size of the ureters increases (approx. 1 centimeter) because of the increased renal blood flow and interstitial volume in pregnancy. The ureters and the collecting system also lose their capacity to contract, leading to dilation and occasionally discomfort. The main concern with dilation is the static nature of urine. If the urine isn’t eliminated, stones or infection may be present. The changes typically occur during the second trimester. They will disappear after birth.
  • In addition, when pregnant, a range of changes that occur with minerals and vitamins could result in kidney stones. In this condition, the body’s ability to deal with calcium less effectively can lead to the onset of the formation of kidney stones.
  • Urinary tract infections are a common occurrence during pregnancy and can cause kidney stones.
  • The body’s need for water also increases during pregnancy. Insufficient fluid intake could result in dehydration and may contribute to the formation of kidney stones.

A typical clinical presentation for kidney stones

The stones are found inside the ureter about twice as frequently as in the kidney and affect the ureters with equal amounts. It is often misdiagnosed as appendicitis or mistakenly diagnosed as diverticulitis (inflammation of the colon or wall) or abruption of the placenta. Here are some typical signs to watch out for:

  • Colic in the stomach or abdominal or flank discomfort.
  • The groin is aching and painful.
  • The occurrence of nausea and vomiting
  • Dysuria, pain, and frequent urinary frequency
  • Blood or haematuria in the urine

If the stone doesn’t pass, it can trigger premature labor create painful urinary tract infections or sepsis. It could also hinder the normal progress of labor.

Diagnostics of Kidney Stones during pregnancy

Urolithiasis in pregnancy is typically an indication of a therapeutic and diagnostic problem. About 80-90% of urinary stones can be diagnosed once the first trimester has passed. Here are the various ways to detect the disease:

  • Lab Assessment A urine culture and sensitivity test may confirm the presence of infection. A blood test can also check kidney function. An increase in serum calcium levels requires further examination.
  • Diagnostic Radiological Procedure It comprises Magnetic Resonance imaging or Magnetic Resonance Urography. The dangers of radiation depend on the age of the fetus. Low-dose protocols for treating stones can be justified in certain instances. Because of the risk of foetus doctor don’t recomend x-rays
  • Ultrasonography(US) is the primary option to detect kidney stones during pregnancy. However, ultrasound doesn’t always reveal any rocks. Only experienced professionals can perform procedures for US or doppler US.
  • Intravenous Urography, or CT scanning only if symptoms persist or cause other complicated problems This option is only available during pregnancy.
  • The Nuclear Renography – A radioisotope is injected in the vein of a radiologist to examine the kidneys. It’s to look for functional studies.
  • MRI has limited value in these situations.

Kidney Stone Disease Treatment & Management

Let’s examine the kidney treatment for stones and their management during pregnancy.

  • Conservative administration
  • Patients are advised to relax and have a sufficient intake of fluids and medications to aid in managing the condition. The majority of stones (70-80 percent) are cleared up on their own after moderate treatment.
  • Invasive treatments
  • Any manipulation to the pelvis, bladder, kidney, or ureter can cause premature labor. But, the most important treatments are:
    • StentingA stent, also known as a PCN tube, is placed inside the urinary tract. The tube carries urine and reduces the pressure on the urinary tract. The tube remains in place until the end of pregnancy.
    • Extracorporeal Shock Wave Lithotripsy – ESWL uses ultrasonic pulses to break up renal stones. It is completely unsuitable during pregnancy since it could cause fetal harm and even death, although the procedure is recommended to women not expecting.
    • Ureteroscopic Stone Removal (URS) is the most recommended procedure for pregnant women when stone removal is necessary. Holmium is used to break up stones and can be used instead of ESWL.
    • Percutaneous Nephrolithotomy (PCNLs) – An access tract is made within the kidney collecting system. Although its efficacy and safety have been proven for women who are not pregnant, however, it is not recommended during pregnancy due to general anesthesia and prolonged sitting in a prone position.

Preventing bladder stones during the pregnancy

Preventing urinary stones in pregnancy is essential and is the best treatment. Here are some simple ways to avoid them for you to follow

  • Get plenty of fluids and water to keep your body well-hydrated.
  • Don’t sit on the urine, even if that means regular trips to the bathroom or the toilet.
  • Reduce consumption of high oxalate food items like chocolates, nuts, and dark green leafy vegetables and fruits
  • Discuss treatment options with a doctor before planning a pregnancy, mainly if there is a history of kidney stones.
  • Exercise regularly and physically in accordance with the advice of your doctor.
  • Contact a doctor right away in case of extreme pain in the abdomen area.