Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

Abstract

Importance: Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.Objective: This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.Evidence Acquisition: A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.Results: The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.Conclusions: When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.Relevance: Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to identify the risk factors of spontaneous renal rupture in pregnancy; outline the presenting signs and symptoms of renal system rupture during pregnancy; explain the preferred diagnostic tools and imaging modalities for diagnosing renal system rupture in pregnancy, including the risks and benefits to the fetus; and describe the management and potential complications of pregnant patients presenting with renal system rupture.Renal rupture is a rare complication of pregnancy with a limited number of cases reported in the medical literature. [1][2][3] Spontaneous renal rupture is diagnosed when rupture occurs without recent surgery or trauma. 2,4 The concept of spontaneous renal rupture in the general population was introduced by Wunderlich in 1856, and the first case of urinary tract rupture during pregnancy was reported by Campbell 5 in 1947. 1,4 Because of the limited amount of information in the literature, it may be difficult to determine the diagnosis and appropriate management plan from both a urologic and obstetrical standpoint.All authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity. Disclaimer: J.A.P. is an active duty member of the Armed Forces. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. The investigators have adhered to the policies for protection of human subjects as prescribed in 45 CFR 46.

Spontaneous renal rupture caused by factor VII deficiency: A case report

“…Spontaneous renal rupture usually occurs after upper urinary calculi-related operation treatment or renal tumor, [ 2 , 4 ] it has also been reported during pregnancy, [ 5 ] transplant kidney and nephritis. [ 6 , 7 ] According to the location of renal rupture, it can be divided into renal parenchyma rupture, collecting system rupture or mixed rupture, [ 1 ] patient may experience corresponding symptoms, such as pain, hematuresis and Wunderlich syndrome.…”