Renal colic in pregnancy: lithiasis or physiological hydronephrosis?

Area of Science:

• Urology
• Diagnostic Imaging
• Nephrology

Background:

• Renal colic is a common condition often caused by urinary calculi (stones) or physiological hydronephrosis.
• Differentiating between these causes using standard clinical and laboratory features can be difficult.
• Accurate diagnosis is crucial for appropriate and timely treatment.

Purpose of the Study:

• To evaluate the diagnostic accuracy of investigations for differentiating urinary calculi from hydronephrosis in renal colic.
• To assess the effectiveness and appropriateness of treatments for these conditions.
• To identify reliable indicators for the presence of urinary stones.

Main Methods:

• Retrospective review of 300 consecutive patients presenting with renal colic.
• Analysis of clinical presentation, laboratory data, and diagnostic imaging findings.
• Inclusion of 262 patients in the final analysis after data review.

Main Results:

• Most clinical and laboratory features were not helpful in predicting stones; left-sided colic was a significant indicator (P = .003).
• Ultrasound accuracy improved to 71.9% when obstruction features (e.g., ureteric jet absence, elevated resistive index) were included.
• Patients with stones had lower spontaneous resolution rates (63% vs 85%) and higher intervention needs (29.2% vs 5.9%).

Conclusions:

• Clinical signs are generally unreliable for diagnosing the cause of renal colic.
• Enhanced ultrasound is a reasonably accurate initial diagnostic tool for suspected urinary calculi.
• Endoscopic interventions, such as ureteroscopy and stent insertion, are safe and effective for managing stones, even during pregnancy.