Burden of Symptomatic Renal Stones in Pregnancy Managed Till Normal Delivery: A Case Report in Developing Nation

Abstract

Although urolithiasis occurs in pregnancy, its management remains a great challenge in our region. It creates a diagnostic puzzle due to many differentials that can simulate the symptoms in pregnancy. This is further challenged by the limitations of the accepted imaging investigations, burden of monitoring the pregnancy and managing urolithiasis till delivery at term. We present a case of intractable flank pain due to left renal calculus in an eighteen year old primigravida which was successfully managed. Where possible, treatment of urolithiasis before conception should be our focus in addition to general preventive measures of urolithiasis.Keywords: Urolithiasis; Pregnancy; Stones; Hydronephrosis abdominal pain that requires admission of pregnant patients [3]. Also the risk of pre-term delivery due to nephrolithiasis has doubled the one in pregnant women without nephrolithiasis [2], hence the need for commitment in the management of this category of patients. Maternal kidney stones are significantly associated with several pregnancy complications, including recurrent abortions, hypertensive disorders, gestational diabetes and increase in the number of caesarean deliveries [4]. Urolithiasis in pregnancy may be more common in multiparous women, and more commonly present during the second and third trimesters [5]. Generally, men have been reported in the past to have higher urolithiasis than women, but the overall man to woman ratio were reported later to have decreased from 3.1:1 to 1.3:1 during a 30 year period in a city of united states [6]. The increasing incidence of nephrolithiasis these women might be due to lifestyle associated risk factors, such as obesity. Diagnosing urolithiasis in pregnancy remains a great challenge, because many differential diagnoses can exist in pregnancy, and also the common symptoms and signs may be silent in some patients. We present a case of left ureteric stone in pregnancy. Case PresentationA.A.I was an eighteen year old unbooked primigravida with estimated 3 months old gestation, presented to the Gynaecology Emergency unit with a sudden worsening episode of colicky left flank pain, which preceded several episodes of left flank pain for the past 4 years that were relieved by oral analgesics. No symptoms in the right flank. There was occasional high grade fever with chills, no passage of calculus through the urethra and no Lower Urinary Tract Symptoms (LUTS). Also no hematuria recently or during childhood. There were episodes of vomiting but no other gastro-intestinal symptoms. Gynecological history and other systems were normal. No past history of pelvic surgery. She is not a sickle cell disease or diabetic patient.Examination revealed a young woman, in pain distress, afebrile, not pale, not jaundiced, and not dehydrated and no pedal edema. Vital signs were within normal limit. Abdomen was full, moved with respiration, no tenderness at the renal angle or other parts of the abdomen. The liver and spleen were not enlarged and the kidneys were not ballotable. The uterus ...