Thursday, June 26, 2014

Kidney Stones and Pregnancy: What Every Woman Should Know

Kidney Stones and Pregnancy: What Every Woman Should Know

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Kidney Stones and Pregnancy: What Every Woman Should Know

Posted: 25 Jun 2014 08:00 AM PDT

Pregnant women can get kidney stones

Kidney stones affect both the mother and the unborn baby, negatively impacting health, development, and delivery. Now, being pregnant doesn’t necessarily increase the chances you’re going to develop kidney stones, but it is important to note that being pregnant can increase the difficulty in remedying them… and every pregnant, or may-become pregnant, woman should pay special attention to habits that discourage kidney stones.

Why Should Pregnant Women Be Aware of Kidney Stones?

Aside from being extremely painful, kidney stones can affect the fetus and complicate birth — sometimes even causing preterm labor. Addressing kidney stones early is absolutely vital for drastically reducing the likelihood of premature delivery. [1]

What Causes Kidney Stones?

There are a variety of factors that contribute to kidney stones, including:

Fluid Intake

Not consuming enough water will tend to promote urine that is highly concentrated with nutrients like calcium or phosphorus, dramatically increasing the risk for developing kidney stones. [2]

Your Genes

Genetic factors also play a role in kidney stone formation. Families who have a high incidence of hypercalciuria, a condition where an abnormal amount of calcium is leached out into the urine, will have a heightened risk for developing kidney stones. [3]

Bowel Irritation

If gastrointestinal sensitivity is a problem for you, take note. Chronic inflammation of the bowels can increase your risk for developing kidney stones, especially during pregnancy. [4]

Calcium Intake

Pregnant women typically need additional nutrients, including calcium. Too much calcium, however, can strain the kidneys. Additionally, calcium absorption is increased during pregnancy. Both of these factors can elevate the risk for developing stones. [5]

UTIs

Anatomical and physiological changes during pregnancy can increase a woman’s risk of developing kidney stones. Chronic and persistent urinary tract infections may be a symptom of kidney stones. Pregnant women who suffer from UTIs should mention and discuss the problem with their healthcare provider. [6]

What to do?

For most people, a stone is a painful experience; yet, around 70-80% of stones pass spontaneously without intense medical intervention. If an aggressive approach is required, surgery may be considered or even required.

X-rays

X-rays are a method of choice for determining stone presence; however, most health professionals discourage their use during pregnancy. Radiation is emitted from X-ray machines, possibly affecting the developing fetus. [7] Currently, very little research is available to determine the exact effects radiation has on both the mother and the unborn child. With the risks of surgery and anesthesia, not to mention the risk of radiation exposure, minimally-invasive approaches are often the best course of action for pregnant women. [8]

Ureteroscopy

A ureteroscopy involves placing a thin tube in the urethra to the site of the kidney stones, effectively removing them from the body. [9] As the complication rate for ureteroscopy during pregnancy is relatively low, it's no wonder why physicians are becoming increasingly fond of using this stone-removal method. [10]

Shockwaves

Shockwave therapy uses sound waves to target and fragment stones and is a highly-utilized, minimally-invasive treatment. [11] While it’s safe for most people, it’s not clear if it’s a viable option for pregnant women. [12] The effects of sound waves on the developing fetus is too much of a risk, and most researchers and experts discourage the practice. [13]

Patience

Conservative management like bed rest and hydration can encourage stone passage. Medications aren’t good during pregnancy as most are contraindicated as the use of drugs may interfere with fetal health. [14]

Were kidney stones a problem for you during pregnancy? How did you deal with them? Please leave a comment below and share your experience with us!

-Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM

References:

  1. Proia L, Lippa A, Valente A. Review on renal calculosis in pregnancy. Clinical Therapeutics. 1997 December;148(12):667-73.
  2. Carter MR, Green BR. Renal calculi: emergency department diagnosis and treatment. Emergency Medical Practice. 2011 July;13(7):1-17.
  3. Bushinsky DA, Asplin JR, Grynpas MD, Evan AP, Parker WR, Alexander KM, Coe Fl. Calcium oxalate stone formation in genetic hypercalciuric stone-forming rats. Kidney International. 2002 March;61(3):975-87.
  4. McConnell N, Campbell S, Gillanders I, Rolton H, Danesh B. Risk factors for developing renal stones in inflammatory bowel disease. BJU International. 2002 June;89(9):835-41.
  5. Leanne Kolnick, MD, Bryan D. Harris, MD, David P. Choma, MD, PhD, and Neesha N. Choma, MD, MPH. Hypercalcemia in Pregnancy: A Case of Milk-Alkali Syndrome. Journal of General Internal Medicine. August 2011; 26(8): 939-942.
  6. Marlow RA. Nephrolithiasis in pregnancy. American Family Physician. 1989 September;40(3):185-9.
  7. Buchholz NP, Biyabani R, Sulaiman MN, Talati J. Urolithiasis in pregnancy–a clinical challenge. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1998 September;80(1):25-9.
  8. Denstedt JD, Razvi H. Management of urinary calculi during pregnancy. The Journal of Urology. 1992 September;148(3 Pt 2):1072-4.
  9. Evans HJ, Wollin TA. The management of urinary calculi in pregnancy. Current Opinion in Urology. 2001 July;11(4):379-84.
  10. Semins MJ, Matlaga BR. Management of stone disease in pregnancy. Current Opinion in Urology. 2010 March;20(2):174-7. doi: 10.1097/MOU.0b013e3283353a4b.
  11. Monga M. Treating urinary tract stones: common questions about a common problem. Minnesota Medicine. 2010 August;93(8):36-8.
  12. Ackermann D, Merz V, Marth D, Zehntner C. Clinical experiences with extracorporeal shockwave lithotripsy. Swiss Medical Weekly. 1989 July 1;119(26):935-40.
  13. Asgari MA, Safarinejad MR, Hosseini SY, Dadkhah F. Extracorporeal shock wave lithotripsy of renal calculi during early pregnancy. BJU International. 1999 October;84(6):615-7.
  14. Maikranz P, Coe FL, Parks JH, Lindheimer MD. Nephrolithiasis and gestation. Baillière’s Clinical Obstetrics and Gynaecology. 1987 December;1(4):909-19.d

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