Renal colic (RC) during pregnancy refers to the occurrence of severe, crampy pain in the lower back or side, typically resulting from the presence of kidney stones in pregnant women. Kidney stones are solid deposits that form in the kidneys and can cause significant discomfort when they obstruct the urinary tract. Pregnancy itself can increase the risk of developing kidney stones due to hormonal changes and alterations in urinary function.

The symptoms of RC during pregnancy may include intense pain, often radiating to the lower abdomen and groin, along with nausea and vomiting. Diagnosing and managing renal colic in pregnant women poses unique challenges, as certain diagnostic procedures and treatment options must be approached with caution to ensure the safety of both the mother and the developing fetus.

Medical professionals will carefully assess the situation, considering the potential risks and benefits of various diagnostic and therapeutic interventions. Treatment may involve pain management, hydration, and, in some cases, conservative measures to facilitate the passage of kidney stones. Close monitoring and collaboration between obstetricians and urologists are crucial to ensure the well-being of both the pregnant woman and her unborn child during the management of renal colic.

What is renal colic during pregnancy

Renal colic during pregnancy refers to the presence of kidney stones and the associated severe pain in pregnant women. Kidney stones are solid crystalline deposits that form in the kidneys and can cause blockages or irritation in the urinary tract. During pregnancy, hormonal changes and shifts in the urinary system’s function can increase the risk of developing kidney stones.

When a pregnant woman experiences kidney stones, she may suffer from RC, which is characterized by intense, crampy pain. This pain typically originates in the lower back or side and may radiate to the lower abdomen and groin. Other symptoms can include nausea and vomiting.

What are the reasons?

The causes of renal colic during pregnancy are similar to those in non-pregnant individuals, but pregnancy itself can contribute to an increased risk. Here are some factors that can lead to renal colic during pregnancy:

• Hormonal Changes: Pregnancy hormones, particularly progesterone, can lead to changes in the urinary tract, potentially slowing down the flow of urine. This stagnation can contribute to the formation of kidney stones.
• Dehydration: Pregnant women are at an increased risk of dehydration, which can promote the crystallization of minerals in the urine, forming kidney stones. Limited fluid intake or increased fluid loss due to vomiting, common in pregnancy, can exacerbate this risk.
• Urinary Stasis: As the uterus expands during pregnancy, it can exert pressure on the ureters (tubes connecting the kidneys to the bladder), causing a slowdown of urine flow. This urinary stasis can contribute to the formation of kidney stones.
• Dietary Factors: Certain dietary factors, such as a high intake of salt or certain foods, may contribute to the development of kidney stones. Pregnancy cravings or aversions can also affect dietary choices.
• Genetic Predisposition: A family history of kidney stones may increase the likelihood of developing them during pregnancy.
• Pre-existing Conditions: If a woman had a history of kidney stones before pregnancy, she may be at an increased risk of experiencing renal colic during pregnancy.
• Pre-existing Conditions: Women with a history of kidney stones before pregnancy may be at a higher risk of experiencing renal colic during pregnancy.
• Increased Calcium Absorption: During pregnancy, the body may absorb more calcium from the intestines, which can lead to elevated levels of calcium in the urine, a factor that can contribute to stone formation.
• Changes in Uric Acid Levels: Pregnancy can alter the balance of uric acid in the body, potentially increasing the risk of certain types of kidney stones.

Is renal colic significant during pregnancy, if so why?

Yes, “renal colic during pregnancy” is significant, and here are several reasons why:

• Pain and Discomfort: RC is associated with intense, crampy pain, which can be highly distressing for pregnant women. The pain can be severe and may require prompt medical attention for relief.
• Increased Risk in Pregnancy: Hormonal changes, dehydration, and altered urinary dynamics during pregnancy can increase the risk of developing kidney stones, leading to renal colic. The occurrence of renal colic in pregnant women may be more common than in the general population.
• Potential Complications: Kidney stones can cause complications such as urinary tract infections, blockages, or damage to the kidneys. During pregnancy, these complications could pose risks not only to the mother but also to the developing fetus.
• Diagnostic Challenges: Diagnosing and managing renal colic during pregnancy can be challenging due to concerns about the impact of diagnostic tests and treatments on the health of both the mother and the unborn child.
• Management Considerations: Treatment options must be carefully chosen to avoid harm to the fetus. Conservative measures such as pain management, hydration, and monitoring are often employed, but the situation may require close collaboration between obstetricians and urologists to ensure a balanced and effective approach.
• Potential Impact on Pregnancy Outcome: In severe cases or when complications arise, there may be potential implications for the overall health and outcome of the pregnancy. Therefore, proper assessment and management are crucial to mitigate risks.
• Patient Well-being: The discomfort and pain associated with renal colic can affect a pregnant woman’s overall well-being and quality of life. Managing the condition effectively is essential to ensure the best possible outcome for both the mother and the baby.

Due to these factors, healthcare providers take RC during pregnancy seriously and work to provide appropriate care that addresses the unique considerations of pregnancy while managing the condition effectively.

Diagnosis of renal colic during pregnancy

Diagnosing RC during pregnancy involves a careful assessment of the patient’s symptoms, medical history, and various diagnostic procedures. However, the approach needs to be cautious to ensure the well-being of both the pregnant woman and the developing fetus. Here are key components of the diagnostic process:

1. Medical History and Physical Examination:

• The healthcare provider will inquire about the patient’s symptoms, including the nature, location, and intensity of the pain.
  • A detailed medical history, including any previous episodes of kidney stones or urinary issues, will be taken.
  • A physical examination may be conducted to assess vital signs, abdominal tenderness, and other relevant factors.

• Laboratory Tests:

• Urinalysis: Examination of a urine sample can reveal the presence of blood, crystals, or infection, providing clues to the underlying cause.
  • Blood tests: These may include a complete blood count (CBC) and metabolic panel to assess kidney function and identify any metabolic abnormalities.

• Imaging Studies:

• Ultrasound: Ultrasonography is often the preferred imaging method during pregnancy as it doesn’t involve ionizing radiation. It can detect the presence of kidney stones and assess the condition of the kidneys.
  • MRI (Magnetic Resonance Imaging): In certain situations, an MRI may be considered if additional information is needed. However, it is generally avoided during the first trimester due to safety concerns.

• Avoidance of Ionizing Radiation:

• X-rays and CT scans are generally avoided or used sparingly during pregnancy, especially in the first trimester, due to potential risks to the developing fetus. If deemed necessary, precautions will be taken to minimize radiation exposure.

• Collaboration Between Specialists:

• Obstetricians and urologists often collaborate closely in the diagnosis and management of renal colic during pregnancy. The treatment plan needs to consider the unique aspects of pregnancy to ensure the safety of both the mother and the unborn child.

• Monitoring and Follow-up:

• Continuous monitoring of the patient’s condition may be necessary, and follow-up assessments can help track the resolution of symptoms or identify any complications.

What is the treatment?

The treatment of RC during pregnancy involves managing the symptoms and addressing the underlying cause, which is often the presence of kidney stones. However, due to the unique considerations of pregnancy, the approach needs to be carefully tailored to ensure the safety of both the mother and the unborn child. Here are key aspects of the treatment:

• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are commonly used to relieve pain associated with renal colic. However, their use is generally avoided during the third trimester due to potential effects on the fetal cardiovascular system. Acetaminophen may be considered for pain relief, as it is generally considered safer during pregnancy. The choice of pain medication will depend on the specific circumstances and the trimester of pregnancy.
• Hydration: Adequate hydration is crucial to help flush out the urinary system and promote the passage of kidney stones. Intravenous (IV) fluids may be administered if oral intake is insufficient or if there is dehydration.
• Monitoring and Observation: Continuous monitoring of the pregnant woman’s vital signs, urine output, and overall well-being is important. Regular ultrasound assessments may be performed to monitor the status of the kidneys and the passage of kidney stones.
• Conservative Measures: Encouraging physical activity and changes in position may aid in the movement of kidney stones. Dietary modifications, such as adjustments to salt and calcium intake, may be recommended based on the type of kidney stones.
• Collaboration Between Specialists: Obstetricians and urologists will collaborate to tailor the treatment plan to the unique needs of the pregnant patient. In some cases, consultation with a maternal-fetal medicine specialist may be beneficial, especially if there are concerns about the impact of the condition on the pregnancy.
• Avoidance of Certain Interventions: Certain diagnostic and therapeutic interventions, such as contrast-based imaging studies and surgical procedures, may carry risks during pregnancy and are generally avoided or approached cautiously.
• DJ cathether: A ureteral double-J (DJ) catheter is a medical device that is sometimes used in the management of renal colic during pregnancy, particularly when kidney stones are causing obstruction or complications. This intervention is generally considered when conservative measures are insufficient, and there is a need to address the underlying cause of the colic. It’s important to note that the decision to use a ureteral DJ catheter during pregnancy is made on a case-by-case basis, weighing the risks and benefits for both the mother and the unborn child. Close collaboration between obstetricians and urologists is essential to ensure the safety and well-being of the pregnant woman while addressing the underlying cause of renal colic.
• Delivery Planning (if applicable): If the renal colic is severe, persistent, or associated with complications that pose a risk to the mother or fetus, the healthcare team may consider the timing and mode of delivery.

The specific treatment plan will depend on the severity of symptoms, the gestational age, and the underlying cause of renal colic. It is crucial for pregnant women to work closely with their doctor to ensure a comprehensive and safe approach to managing RC  during pregnancy.

Conclusion

In conclusion, renal colic during pregnancy is a significant clinical concern that requires careful attention and specialized care. The condition, often associated with the presence of kidney stones, can lead to severe pain and discomfort for pregnant women. The unique physiological changes of pregnancy, including hormonal shifts and alterations in the urinary system, contribute to an increased risk of developing kidney stones.

Diagnosing RC during pregnancy involves a thorough evaluation, considering the pregnant woman’s symptoms, medical history, and the potential impact on both the mother and the developing fetus. Imaging studies, such as ultrasound, play a crucial role in identifying the presence of kidney stones while minimizing risks to the pregnancy.

Treatment strategies are designed to manage symptoms effectively while prioritizing the safety of the mother and the unborn child. Pain management, hydration, and conservative measures are often employed, with a careful selection of medications that are considered safe during pregnancy. In certain cases, interventions like the placement of a ureteral DJ catheter may be necessary to address obstruction caused by kidney stones.

Collaboration between obstetricians and urologists is vital in developing a comprehensive and individualized treatment plan. Regular monitoring and follow-up assessments help track the progress of the condition and ensure timely adjustments to the management approach.

While RC during pregnancy poses challenges, advancements in medical care and a multidisciplinary approach contribute to optimizing outcomes. Timely and appropriate interventions, along with close medical supervision, can help alleviate symptoms, mitigate potential complications, and safeguard the health of both the pregnant woman and her unborn child.

Pof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKEY