A Spontaneous Renal Calyceal Rupture Mimicking Physiologic Changes of Pregnancy and Other Common Pathologies

Abstract

A spontaneous renal calyceal rupture in pregnancy is extremely rare and can be challenging to identify as its presentation can mimic other more common diagnoses, which can lead to a delay in management. Here, we describe an unusual case of renal calyceal rupture in a 24-year-old G2P0010 female with pregnancy at 26.5 weeks gestation age (WGA) who was admitted to the antepartum ward due to left flank pain and uterine contractions. A renal sonogram was performed, which revealed severe left hydronephrosis and the absence of the ipsilateral ureteral jet. Urinalysis was within normal limits, and her renal function was preserved. Laboratories were remarkable for elevated liver enzymes. Finally, an abdominopelvic MRI revealed the culprit, a calyceal rupture. Once the diagnosis was clear, a double J-stent was inserted using limited fluoroscopy with the goal of reducing intrarenal pressure and decreasing disease morbidity. The patient’s symptoms significantly improved after double J-stent placement and resolved the following day. The patient further developed preeclampsia with severe features, which has previously been documented to occur in pregnant patients with renal tract ruptures. The diagnosis of a renal calyceal rupture in pregnancy is not straightforward, in part because of a lack of awareness of this pathology. Nevertheless, early identification can prevent unnecessary interventions and adverse outcomes. Its diagnosis can be made with MRI, and its management with ureteral stent placement shouldn’t be delayed, and its association with preeclampsia should be further explored.