Urolithiasis during pregnancy

Urogenital disease during pregnancy can be found infrequently. A higher risk of developing the disease in pregnant women, whose age exceeds 35 years. Pregnancy is not the cause of kidney stones, but it is an important risk factor. The woman during the bearing of the baby can expand the ureters, because of which the stones begin to move more intensively and there is an attack of severe renal colic. For pregnant women who have chronic kidney disease, a prognosis regarding the course of the underlying disease and regarding the outcome of pregnancy as a whole is favorable.

Epidemiology

The incidence of urolithiasis in pregnant women is about one case for 1500 pregnancies.

[1], [2], [3]

Causes of the urolithiasis during pregnancy

Urolithiasis has a complex of causes, there is no single factor that leads to the formation of stones. The etiology of urolithiasis in pregnant women does not differ significantly. As a rule, the disease manifests itself when the complex effect on the body of several factors:

• metabolic disorders;
• congenital pathologies of the excretory organs leading to a violation of the outflow of urine;
• disorders in the endocrine system;
• a change in the acidity of urine, normally there should be a weakly acidic pH reaction, but acidity may be impaired due to dietary habits;
• the defeat of the organs of bacterial secretion, which can proceed imperceptibly and without symptoms until a certain moment;
• disturbance of nervous regulation of the excretory system;
• disruption of the gastrointestinal tract;
• heat, leading to dehydration;
• the side effects of certain medicines;
• physical inactivity.

A common cause that affects the development of urolithiasis in pregnant women is a disturbed outflow of urine. This often occurs in late pregnancy, when the uterus increases significantly in size and presses on the kidneys. Because of this, urine stagnates, and conditions for the development of infectious diseases are created, resulting in the occurrence of pyelonephritis in pregnant women.

Also, the frequent cause of kidney stones is a high concentration of urine, since the body of a pregnant woman is prone to swelling due to disruption of the kidneys. In this case, the pregnant woman is strongly recommended to limit, as far as possible, the use of liquid, which reduces the volume of urine, but increases the concentration.

[4], [5], [6]

Risk factors

• Heredity.
• Age (30-50 years).
• Insufficient water consumption.
• Dry and hot climate.
• A diet high in calcium, sodium and red meat.
• Social class.

[7], [8], [9]

Pathogenesis

Urinary stasis and hypercalcemia, weakened peristalsis, physiological hydronephrosis, infections, and increased calcium excretion during pregnancy are possible pathogenetic mechanisms of urolithiasis.

[10], [11], [12]

Symptoms of the urolithiasis during pregnancy

It is important for a woman to be aware of the course and symptoms of urolithiasis during pregnancy. Then it will be possible to find out about the disease earlier and get timely qualified help. The first sign of exacerbation of urolithiasis is paroxysmal pain in the lower back, heat, nausea, swelling in the intestine, painful urination. When the attack of colic passes, the stones can themselves move away from the urine. At the end of the attack, you can see that the urine has acquired a reddish color due to damage by the stones of the urinary tract mucosa.

Complications and consequences

In 10-20% of cases of urolithiasis during pregnancy, a urinary tract infection develops. There is a risk of premature birth.

[13], [14], [15], [16], [17]

Diagnostics of the urolithiasis during pregnancy

To diagnose a disease, it is necessary to collect data for an anamnesis:

• describe the strength and duration of pain;
• describe the associated symptoms;
• the presence of blood in the urine;
• to find out whether surgical intervention was performed on the urinary tract;
• whether there are disturbances in the digestive system;
• presence of illness in blood relatives;
• what medications the patient takes;
• whether there were earlier fractures of bones.

For diagnostics use laboratory researches and methods of instrumental diagnostics.

Ultrasound is recognized as the safest and informative study. An important role in the diagnosis is X-ray. Excretory urography allows you to get information about the state of the kidneys and the location of the stone, help to get an idea of the functioning of the kidneys. In exceptional cases, when the final diagnosis can not be made based on the results of these examinations, retrograde ureteropyelography is used.

Computed tomography is practically not used, since exposure to X-rays to pregnant women is contraindicated.

Laboratory studies will determine the chemical composition of the stone and detect metabolic disturbances that have caused it. A blood test can detect nonspecific inflammatory changes (an increase in ESR, a shift of the leukocyte formula to the left, an increase in the C-reactive protein). To get the full picture, the doctor can prescribe an analysis for the determination in the blood of the level of urea, creatinine, calcium, protein, urine density, the presence of bacteria.

The results of the research will predetermine the tactics of treatment.

[18], [19]

Differential diagnosis

For differential diagnosis, in order to distinguish urolithiasis from appendicitis, tumors of the ureter, pyelonephritis or glomerulonephritis use retrograde endoscopic ureteropyeloscopy.

[20]

Treatment of the urolithiasis during pregnancy

Treatment of the disease between exacerbations consists in combating the inflammatory process, destruction and subsequent excretion of calculi. For this traditionally used treatment with the help of herbs and mineral waters. Reduce the recovery time will help alternative recipes.

Drug treatment of urolithiasis during pregnancy aims at getting rid of spasms, destruction and excretion of concrements, elimination of inflammation. Treatment takes a long time, requires regular intake of phytotherapeutic drugs, herbs, mineral water, as well as medications that relieve pain and spasms.

Drugs for treatment of urolithiasis

Plants helped to fight against urolithiasis long ago. Then the pharmacists developed the combined preparations, which are based on plant extracts.

• Cyston. Produced in the form of tablets and consists of extracts of herbs. The drug is valuable in that it can destroy stones, while contributing to the removal of inflammation and spasms. The diuretic effect of Cyston helps to cleanse the kidneys. To remove the stones, it is prescribed in a dosage of 2 tablets three times a day. The course of therapy - 3-4 months. Does not cause side effects, its reception is safe with urolithiasis during pregnancy.
• The cystenal. Used for prophylaxis, as well as during the acute phase of the disease. It includes extracts of the root of the dyeing world, essential oils, olive oil. Has an antispasmodic effect. If during the period of taking the drug to increase the use of fluid, it will help to ease the withdrawal of calculi. It is prescribed in a dosage of 3-5 drops 3 times a day for half an hour before meals. Drops can be diluted with water.
• Kanefron. Combined drug based on medicinal herbs, promotes the removal of salts and minor concrements, eliminates inflammation. Available in the form of drops and pills. It is prescribed in a dosage of 2 drops (or 50 drops) 3 times a day.
• Phytolysin. It is made on the basis of the extract of the saber and the root of the wheat grass, and also contains other medicinal herbs. Phytolysin promotes excretion of stones and crystallized salt, is used as a preventive agent that helps to prevent the formation of stones. The drug was not tested for safety during pregnancy. However, the practice of using the drug confirms the absence of a negative effect on the fetus. Phytolysin prevents the reproduction of bacteria that have fallen into the urinary tract.

[21], [22], [23], [24], [25]

Physiotherapeutic treatment

Physiotherapeutic treatment of urolithiasis includes:

Use of sinusoidal modulated currents; Dynamic amplipulse therapy; Ultrasound treatment; laser therapy; inductothermy.

During exacerbations of urolithiasis during pregnancy, it is recommended to refrain from physiotherapy.

Homeopathic treatment

Treatment of urolithiasis with homeopathic preparations must be combined with a specialized diet that provides for refraining from eating foods that are rich in purines (coffee, herring, sorrel). Sometimes it is required to limit the use of dairy products.

In our homeopathic pharmacies, the "chelators" of the manufacturer from Germany "Heel" are most often recommended.

Renel - will help with kidney stones, inflammation of the urinary tract, is effective in the complex therapy for renal colic, morning pain in the kidney area. Renel is produced exclusively in the form of tablets. Dosage: 1 tablet 3 times a day. The duration of therapy is determined by the attending gynecologist with the urologist. For the treatment of urolithiasis during pregnancy is used only after a preliminary consultation with a specialist.

Berberis-Homaccord - used to eliminate inflammation, spasms in the genitourinary tract, bile ducts, gallstones. Effective if the patient periodically develops a renal colic. It is offered in the form of drops and ampoules. Berberis-Homaccord is often used as an auxiliary drug in chronic forms, excessive stress on immunity, the consequences of treating allopathy. Dosage: 10 drops 3 times a day. The duration of treatment is determined by the doctor. The drug is not recommended for use in early pregnancy.

POPULUS compositum is used for effective removal of urine and detoxification in case of disruption of the urinary system, impaired kidney function. Removes inflammation and swelling, eliminates spasms. Populus compositum take 10 drops 3 times a day. On average, the duration of treatment is from one to three months. At pregnancy the preparation can be used after consultation with the doctor.

Solidigrade compositum C is used in complex treatment for exacerbation, as well as for chronic kidney and urinary tract diseases. It is offered only in the form of ampoules for injections. Removes inflammation, eliminates pain and spasms, effectively fights microbes. Dosage in treatment: 1 injection 1-3 times a week.

Herbal Treatment

The use of medicinal herbs enhances the effect of treatment. There are a lot of recipes. For example, 1 hour. Grass horsetail, 1 teaspoon flowers tansy, 2 tsp. Leaf cranberries pour 1 liter of boiling water and boil for several minutes. Then the composition is drunk for 200 grams for half an hour before meals in the morning and evening. The broth has a good diuretic effect and helps fight inflammation.

Eliminate pain and relieve inflammation will help infusion on the leaves of bearberry, herb hernia, mountaineer bird and corn stigmas. To prepare the infusion, the ingredients are taken in equal parts. Infusion drink 50 grams 3 times a day.

The excretion of stones will be facilitated by a mixture of the same parts of honey, vodka, radish juice and beets. Ingredients should be thoroughly mixed and allowed to stand in a dark place for 3-4 days. The composition is taken by 1 tablespoon, diluted in a glass of hot water. The course will need 1 l of tincture.

How can fruits and berries help?

Alternative treatment suggests using both medicinal herbs and ordinary berries, fruits and vegetables.

• Watermelon has a diuretic effect, promotes the washing away of stones. However, to achieve the effect it should be consumed at least 2 kg daily.
• Common cabbage prevents stagnation of urine.
• Cranberry promotes the excretion of urine and fights bacteria.
• Cranberry fruit has the same effect.
• Strawberries prevent stagnation of urine.
• Dill helps to remove excess fluid and salts.
• Notable diuretic effect of pear, barberry, gooseberry and melon.

Operative treatment

There are cases when pregnant women need surgery to remove kidney stones. But this method of fighting urolithiasis is used in extreme cases, since during this period any interference is complicated and its consequences and complications can negatively affect the health of the baby. The best solution for urolithiasis is surgery and sanitation of the urinary tract before conception.

Surgical intervention is required in 20-30% of pregnancies complicated by urolithiasis.

Indications for surgical intervention for urolithiasis during pregnancy:

1. Obstruction of the ureter with an increase in azotemia.
2. Presence of stones in one kidney.
3. Unrestrained pain, despite the ongoing conservative measures.
4. Urosepsis.
5. Renal colic, threatening premature birth.

Prevention

Coping with the formation of new stones and preventing exacerbation of urolithiasis during pregnancy will help correction of metabolic disorders and elimination of factors that cause the formation of stones: activation of blood circulation in the kidneys, intake of sufficient amounts of liquid, elimination of infection, diet, intake of vitamins, physiotherapy.

[26], [27], [28]

Forecast

Diagnosis and treatment of urolithiasis during pregnancy is quite complicated. The forecast is usually favorable.

[29], [30], [31],