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Symptomatic nephrolithiasis complicating pregnancy.

E L Butler1, S M Cox, E G Eberts

  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Obstetrics and Gynecology
|October 24, 2000
PubMed
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Renal ultrasonography is convenient for diagnosing kidney stones in pregnant women but misses 40% of cases. If symptoms persist, single-shot intravenous pyelography is recommended for accurate diagnosis.

Area of Science:

  • Obstetrics and Gynecology
  • Urology
  • Diagnostic Imaging

Background:

  • Nephrolithiasis (kidney stones) complicates approximately 1 in 3300 pregnancies.
  • Symptomatic kidney stones during pregnancy require careful diagnosis and management to ensure optimal perinatal outcomes.
  • Previous diagnostic methods for nephrolithiasis in pregnancy have varied in efficacy and safety.

Purpose of the Study:

  • To review institutional experiences with the diagnosis and management of symptomatic nephrolithiasis in pregnancy.
  • To evaluate the diagnostic efficacy of renal sonography compared to plain x-rays and single-shot intravenous pyelography for initial diagnosis.
  • To assess perinatal outcomes in pregnant women with nephrolithiasis.

Main Methods:

  • A retrospective review of pregnant women admitted for nephrolithiasis between 1986 and 1999.

Related Experiment Videos

  • Evaluation of diagnostic imaging techniques used, including renal ultrasonography, plain abdominal x-ray, and single-shot intravenous pyelography.
  • Analysis of management strategies and perinatal outcomes.

    • Main Results:

    • Fifty-seven pregnant women experienced 73 admissions for symptomatic nephrolithiasis.
    • Renal ultrasonography visualized calculi in 60% of cases, while plain x-rays showed 57%.
    • Single-shot intravenous pyelography (IVP) had the highest diagnostic yield, identifying calculi in 93% of initial uses. Conservative management was successful in 75% of cases, with interventions including ureteral stents and percutaneous nephrostomy tubes.

    Conclusions:

    • While renal sonography is safe and convenient for initial diagnosis of nephrolithiasis in pregnancy, it has a significant miss rate (40%).
    • When clinical suspicion for nephrolithiasis remains high despite negative or inconclusive sonographic findings, single-shot IVP is recommended for definitive diagnosis.
    • Effective management strategies, including conservative measures and interventions, are crucial for favorable perinatal outcomes.