The use of ultrasound in assessing acute renal pain caused by pregnancy

The use of ultrasound in assessing acute renal pain caused by pregnancy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The use of ultrasound in assessing acute renal pain caused by pregnancy Ashraf Talaat Youssef, Maged Salah Eldien Elkady This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3798228/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Acute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. Ultrasonography can help to evaluate for the cause of renal pain either obstructive or non-obstructive. It can help to localize the site of obstruction and can accurately estimate the size of stones. Aim of the work : The purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy among our study group using ultrasound. Methodology: Observational retrospective study in which 87 pregnant females attended to a private ultrasound clinic, all were complaining of severe back pain, their age ranged from 18 to 38 years with the mean age being 28 years. All were subjected to abdominal and obstetric ultrasound exams in addition to clinical and laboratory evaluation. Results: There were 87 pregnant women who experienced acute renal pain. 84 patients presented with hydronephrotic changes and 3 patients showed no dilation of pelvicalyceal systems. Among them hydroureteronephrosis with secondary pyeloureteritis observed in 65cases (75%). Renal stones were detected in 22 cases and 1 case was detected with adult polycystic kidney disease. Conclusion :To evaluate the etiology of renal pain during pregnancy and guide management options, ultrasound is a useful and safe imaging modality. Management of acute renal pain with pregnancy is essential to prevent obstetric or maternal complications, it can be conservative medical and expectant in many cases, with few cases may recommend surgical intervention. Pregnancy Acute renal pain Hydronephrosis Ultrasonography Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 What does this study adds to clinical work Acute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. The purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy and guide management options using ultrasound as safe and a useful imaging modality. Introduction 43–100% of pregnant women are susceptible to hydroureteronephrosis ( 1 ). The right side is affected in almost 85% of cases due to the gravid uterus compressing the right ureter ( 2 ). It commences at 20 weeks of gestation and progresses as pregnancy continues, becoming more noticeable during the third trimester ( 3 ). Acute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. It may lead to preterm delivery, premature rupture of membranes due to hazards of pain severity and frequent vomiting. Maternal systemic sepsis and acute renal injury are possible outcomes ( 4 ). Many imaging modalities can help to diagnose the cause of acute renal pain in conjunction with laboratory tests, among the imaging modalities, ultrasonography is considered safe, available and cheap diagnostic modality. The risks of radiation exposure and hazards to the foetus are associated with both computed tomography and conventional X-rays ( 3 , 5 ). Although MRI is not readily available, it is considered an expensive imaging technique with lower sensitivity in detecting small stones ( 5 ). Ultrasonography can help to evaluate for the cause of renal colic either obstructive or non-obstructive. It can help to localize the site of obstruction and can accurately estimate the size of stones ( 4 ). Estimating an average resistive index in the intrarenal interlobular arteries using colour Doppler can aid in the distinction between obstructive and non-obstructive uropathy ( 6 , 7 ) The optimal way to manage the condition, whether it's surgical intervention or medical and expectant management, will hinge on the precise diagnosis and collaboration between the obstetrician and urologists. The urologist's primary goal is to save the kidney, whereas the obstetrician's primary goal is to save the pregnancy and foetus ( 8 ). Aim of the work : The purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy among our study group using ultrasound. Methodology Observational retrospective study included 87 pregnant females attended to a private ultrasound clinic, all were complaining of severe back pain, their age ranged from 18 to 38 years with the mean age being 28 years , Their gestational age ranged from 7 weeks to 35 weeks, with the main gestational age being 23 weeks. Clinical and laboratory assessments, including a complete blood picture, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), urine analysis and culture, serum urea and creatinine levels, are conducted by the referring clinician for all. All were subjected to abdominal and obstetric ultrasound exams using SonoAce x8 ultrasound machine, Medison, Korea. During the period from May 2021 to December 2022. The obstetric ultrasound examination was to accurately assess the foetus' condition, the number of foetuses, the duration of pregnancy, the location of the placenta, and the amount of liquor. The abdominal ultrasound examination was performed to exclude hepatic masses, cysts or localized collection, to exclude gallbladder stones or inflammatory wall thickening, to exclude peripancreatic pseudocysts, and to exclude appendicitis. Both kidneys were examined to determine if there were any renal stones or hydronephrotic changes. The degree of hydronephrosis was graded into grade1 minimal hydronephrosis, grade11 mildly dilated renal pelvis with non dilated calyces, grade111 moderately dilated renal pelvis with dilated calyces, grade 1V markedly dilated renal pelvis and calyces with attenuated parenchymal thickness ( 3 ). Additionally, to assess the thickness of the mucosal layer in the pelvicalyceal system, the turbidity of urine contents, and the degree of echogenicity in the renal parenchyma. The echogenicity of perinephric fat planes, any perinephric collection. The average resistive index of the interlobar and interlobular arteries was estimated using a colour duplex evaluation. The presence of dilatation, compression or obstruction, obstruction-causing stones, and their size were assessed for both ureters. The urinary bladder was evaluated for its wall thickness, the presence of vesical stones, and the symmetry of colour flow jets from the ureteric orifices using a power Doppler study. Results There were 87 pregnant women who experienced acute renal pain, with 7 of them (8%) attending the exam in their first trimester, 55 of them (63%) attending the exam in their second trimester, and 25 of them (29%) attending the exam in their third trimester. 84 patients (96.5%) presented with hydronephrotic changes and 3patients (3.5%) showed no dilation of pelvicalyceal systems, among 84 patients with hydronephrosis, the degree of hydronephrosis was grade 1 in 4 patients (4.5%), grade 11 in 7 patients (8%), grade111 in 48 patients(55%) and grade 1V in 15 patients (17%) ( Fig. 1 A,B ). The site of hydronephrotic changes was unilateral right sided in 65 patients (77%), left sided in 10 patients (12%), and bilateral in 9 patients (11%). Renal Pyelitis was observed in 75% of cases and was diagnosed by the combination of clinical, laboratory and ultrasound findings. Ultrasound examination showed thickening of the mucosal lining of pelvicalyceal system with turbid urine contents of the pelvicalyceal system, Right renal pyelitis was present in 55 patients (63.5%), left renal pyelitis was present in 10 patients (11.5%), and 22 patients (25%) were found to have no pyelitis. Cystitis was found in 22 patients (25%) and was diagnosed by clinical data and patient complaint of lower urinary tract irritative symptoms, pyuria in urine analysis and thickening of the urinary bladder wall > 4mm in ultrasound examination Renal stones were detected in 20 patients (23%) in our study group. Calcular obstructive hydronephrosis was detected in 10 patients (11.5%) among them 6 patients observed with lower ureteric stones ( Fig. 2 A, B ) and 4 patients detected with renal pelviureteric junction and upper lumbar ureteric stones. ( Fig. 3 A,B,C ).One case showed fundal uterine subserous myoma compressing the course of ureter with subsequent renal back pressure changes with an elevated intrarenal arterial average RI = 0.75 Renal anomalies were incidentally observed among our study group, including 7 patients with ectopic intrapelvic kidneys, one of whom was obstructed with a pelviureteric junction stone. Acute Pyelonephritis with no back pressure changes was detected in 3 cases, presented with acute renal pain ,fever, Bacteriuria ,elevated ESR, elevated C-reactive protein, leucocytosis. The ultrasound examination showed enlarged kidney with heterogenous texture of renal parenchyma, echogenic perinephric fat planes, and one case at 7 weeks of gestation showed an addition 2 left renal abscesses ( Fig. 4 ) and the other 2 patients detected with right pyelonephritis observed at 22 and 35 weeks of gestation. Adult polycystic kidney disease was detected in 1 case at23weeks gestation showing bilateral renal sandy stones and right sided lower ureteric stone ( Fig. 5 A,B ). All obstructed cases had an elevated intra renal arterial Doppler resistive index, which ranged from 0.72 to 0.84, and the average was 0.78. ( Fig. 6 A,B ).No cases of non-obstructive hydronephrosis were detected with an elevated intrarenal average RI > 0.70, ranging from 0.54 to 0.69. 82 cases (94%) presented with acute renal pain were managed with expectant and medical therapy. 5 cases (6%) were managed with surgical intervention, among them 4 cases due to calcular ureteric obstruction, including 2 cases detected with lower ureteric stones and 2 cases detected with large stones at the pelviureteric junction. The size of stones was ≥ 8mm. One case presented with acute pyelonephritis and was complicated with renal abscesses was treated through percutaneous ultrasound guided aspiration of the abscesses and appropriate antibiotic therapy. Discussion According to the present study, acute renal pain can be caused by hydroureteronephrosis, as observed in 84 cases (95.5%) in our study group. Among them, hydroureteronephrosis with secondary pyeloureteritis was observed in 65 cases (75%), renal stones were observed in 20 cases (23%), and ureteric obstruction by stones was observed in 10 cases (11.5%). ureteric compression by uterine myoma in 1 case, a polycystic kidney disease with secondary renal stones in 1 case and acute pyelonephritis without renal back pressure changes in 3 cases. Ultrasound can be used to assess the degree of hydronephrotic changes, to assess the size of the kidneys and the parenchymal echogenicity, to detect renal cysts or renal masses, to evaluate perinephric fat echogenicity in cases with suspected pyelonephritis and to assess the presence of perinephric collection. It can follow the ureteric dilatation to the site of obstruction either with stones or ureteric compression by the gravid uterus ( 3 , 5 ). Evan et al and Butler et al reported that estimating the vascular renal resistive index was consistent with the current study. It can differentiate complete obstruction that shows an elevated estimated resistive index (RI) > 0.70, as observed in all our cases with obstructive uropathy (23% of cases),and incomplete obstructive dilation caused by ureteral compression that shows normal estimated RI ( 6 , 7 ). Patient with anatomical hydroureteronephrosis was frequently involved the right side as observed in 77% of our cases more than left side as observed in 11% of our cases, in agreement with studies reported by Schulman et al and Ciciu et al, due to ureteric compression by the gravid uterus and the narrow angle of the right ureter with respect to left ureter that showed a wide angle during crossing the iliac and ovarian vessels ( 2 , 3 ). The asymmetrical involvement of both the right and left upper urinary tracts makes it more likely to be caused by ureteric compression than a progesterone-related effect. The ureteric compression is usually partial and incomplete, increasing as pregnancy progresses, and is more evident in the third trimester due to uterine enlargement ( 3 ). In most cases, uterine compression caused by a gravid uterus resolves within a few weeks after delivery and can be managed medically without the need for surgical intervention ( 9 ). The present study revealed that acute pyelitis was experienced by 75% of hydronephrosis cases. SAYLAM et al reported that in about 80% of pregnant, hydroureteronephrosis with secondary pyeloureteritis is a common issue that arises because of urinary stasis or cystitis ,leading to an ascending infection in the upper urinary tract. It can complicate surgical intervention with a ureteric stent and can also be found secondary to ureteral obstruction caused by stones ( 10 ). In cases without ureteral stones, conservative management can be achieved through adequate hydration, analgesics, and antibiotic therapy, with excellent results ( 10 , 11 ). Patients who have renal stones are prone to passing stones that obstruct the ureters due to companion pyeloureteric dilation, which is associated with pregnancy and progesterone-related ureteral muscle laxity. Renal stones can pass down to the ureter spontaneously in about 70 to 80% of cases, among them about 50% of cases will expel the stones during the postpartum period ( 4 , 6 , 7 ) ). However, some cases may not pass the stones and require further surgical intervention. The current study revealed that 94% of cases with acute renal pain were successfully managed with medical and expectant treatment, while only 6% were managed with surgical intervention. Predicting surgical intervention involves ureteric stones with a size > 7mm and moderate/marked pelvicalyceal dilation. Pain lasting more than 4 days and fever. Small stones less than 4mm can be treated medically and expectantly when the spontaneous passage rate reaches 50% or more ( 4 ). An associated secondary pyelitis can be treated with antibiotic therapy. Pregnant females with lower urinary tract irritative symptoms should be subjected to perform urine analysis to detect pyuria and abdominal ultrasound to rule out lower ureteric stones and to assess for possible cystitis. To prevent secondary upper urinary tract infections, it is important to manage cystitis adequately. It's crucial for patients with acute pyelonephritis to receive antibiotic therapy that is both adequate and early to prevent complications like renal abscesses, perinephric collections that need to be drained, and to prevent systemic sepsis. Patients with a known history of polycystic kidney disease are more liable to develop renal stones that may pass to obstruct the ureter, therefore should be adequately followed during their pregnancy. Conclusion To evaluate the etiology of renal pain during pregnancy and guide management options, ultrasound is a useful and safe imaging modality. While other imaging modalities may use hazardous radiation or be expensive, it can be used reliably. Management of acute renal pain with pregnancy is essential to prevent obstetric or maternal complications, it can be conservative medical and expectant in many cases, with few cases may recommend surgical intervention. Declarations Conflict of interest : The author declares that he has no conflict interest. Ethical approval : All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (revised version of 2000) (5). Informed consent: All patients provided written informed consent to the enrollment in the study and to the publication of information that could potentially lead to their identification. Funding : No funding. Data Availability: All data generated or analysed in this study were included in the article and no further data recommended to reproduce the results, however if there is any further data required, it will available on reasonable request. References Fried AM, Woodring JH and Thompson DJ: Hydronephrosis of pregnancy: A prospective sequential study of the course of dilatation. J Ultrasound Med 2: 255‑259, 1983. Schulman A and Herlinger H: Urinary tract dilatation in preg‑ Nancy. Br J Radiol 48: 638‑645, 1975 Ciciu E, Paṣatu-Cornea AM, Petcu LC, Tuţă LA. Early diagnosis and management of maternal ureterohydronephrosis during pregnancy. Exp Ther Med. 2022 Jan; 23(1): 27. Do: 10.3892/etm. 2021.10949. Epub 2021 Nov 5. PMID: 34824635; PMCID: PMC8611492. He M, Lin X, Lei M, Xu X, He Z. The identification of pregnant women with renal colic who may need surgical intervention. BMC Urol. 2022 Mar 7;22(1): 30. Do: 10.1186/s12894-022-00985-x. PMID: 35255882; PMCID: PMC8903555. MacNeily AE, Goldenberg SL, Allen GJ, Ajzen SA and Cooperberg PL: Sonographic visualization of the ureter in pregnancy. J Urol 146: 298‑301, 1991. Evans HJ, Wollin TA. The management of urinary calculi in pregnancy. CurrOpin Urol. 2001; 11: 379-384. Butler EL, Cox SM, Eberts EG, Cunningham FG. Symptomatic Nephrolithiasis Complicating Pregnancy. Obstet Gynecol. 2000;96 (5 Pt 1): 753–756. [PubMed] [Google Scholar]. Blanco LT, Socarras MR, Montero RF, Diez EL, Calvo AO, Gregorio SAY, Cansino JR, Galan JA, Rivas JG. Renal colic during pregnancy: Diagnostic and therapeutic aspects. Literature review. Cent European J Urol. 2017;70(1):93-100. Do: 10.5173/ceju. 2017.754. Epub 2016 Oct 28. PMID: 28461996; PMCID: PMC5407324. Fainaru O, Almog B, Gamzu R et-al. The management of symptomatic hydronephrosis in pregnancy. BJOG. 2002;109 (12): 1385-7. SAYLAM B, EFESOY A, ERDEM E. Clinical Course of Pregnant Women with Maternal Hydronephrosis: Retrospective Clinical Study. Duzce Med J. August 2021;23(2):170-173. doi:10.18678/dtfd.917116 Loh K, Sivalingam N. Urinary tract infections in pregnancy. Malays Fam Physician. 2007 Aug 31;2(2): 54-7. PMID: 25606081; PMCID: PMC4170332. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3798228","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":264182588,"identity":"bf8ed398-80d7-47b3-b578-cf56cab2faf8","order_by":0,"name":"Ashraf Talaat Youssef","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYFACHiC2YWDgA7ETKhgYDIjTkmbAwMbAwNjw4AypWhofthGhhb//7LEPPxL+yLOxH37+IHHeYXlz9uYDDD8qtuHUInEjL3lmT4KBYRtPmmFD4rbDhjt7jiUw9py5jduaGzzGDLw/DBjbGBLAWhg33MgxYGZsw61F/vwZY8Y/CQb2bfzPPzYkzjlsT1CLwYEcY2aeBIPENokcoC0NhxMJajG8AdQik2Cc3CbxpnBGwrH05A1njiUcxOcXOZDD3iTI2fbzp2/4+KPG2nbD8eaDD35U4PE+GmgGkweIVg8EdaQoHgWjYBSMghECABL2XMMl7cv+AAAAAElFTkSuQmCC","orcid":"","institution":"Fayoum University Faculty of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Ashraf","middleName":"Talaat","lastName":"Youssef","suffix":""},{"id":264182589,"identity":"8ecfdf8f-a9b7-4663-a96b-86ce2c81ebe4","order_by":1,"name":"Maged Salah Eldien Elkady","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Maged","middleName":"Salah Eldien","lastName":"Elkady","suffix":""}],"badges":[],"createdAt":"2023-12-24 00:11:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3798228/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3798228/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49023951,"identity":"e2191d94-aced-4f11-acc9-05e62993b9e7","added_by":"auto","created_at":"2024-01-01 11:06:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":247151,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eB: B mode ultrasound exam showing right grade 11 hydronephrosis (Fig.1A) and another case with right grade 111 hydronephrosis.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/b55d78bb737f0ab4fd76eb0e.png"},{"id":49023803,"identity":"44690a5a-4a30-4055-974c-7f104a348600","added_by":"auto","created_at":"2024-01-01 10:58:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":239001,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA,B: B mode ultrasound examination showing left grade 11 hydronephrosis with small calyceal stone (Fig.2A) subsequent of left lower ureteric small stone (ST) at the intramural course of left ureter (LU)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/541e98e5b50cf4dc261c6fd8.png"},{"id":49024085,"identity":"1308255a-f9c4-4d45-9b4d-22b9d94f4ee9","added_by":"auto","created_at":"2024-01-01 11:14:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":291865,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA,B: B mode ultrasound examination showing large stone at the right renal pelviureteric junction (Fig.3A) and another case with small stone at the upper lumbar course of the right ureter (Fig.3B)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/07cf81073200312bf0637ffd.png"},{"id":49023952,"identity":"cf051e7b-1ebb-4b1d-b684-5fe24a2f4eb1","added_by":"auto","created_at":"2024-01-01 11:06:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":217439,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eB mode ultrasound of the left kidney (LK) showing 2 cysts with thick walls and turbid fluid contents suggesting of renal abscesses (arrows).\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/d70a07fa28796c643ce7a9da.png"},{"id":49023805,"identity":"88e41550-633a-44dd-928a-0b0e9148c766","added_by":"auto","created_at":"2024-01-01 10:58:11","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":220443,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA,B: - B mode ultrasound examination showing bilateral multiple renal parenchymal cysts suggesting of adult polycystic kidney disease with associated bilateral multiple renal sandy stones.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/4067852a5ec5b5b269b601dc.png"},{"id":49023807,"identity":"f39e2ebe-432d-429d-bf80-24f0e6631f7e","added_by":"auto","created_at":"2024-01-01 10:58:11","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":276570,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eA,B: - colour duplex examination of left kidney in 2 cases showing obstructive hydronephrosis with an elevated intrarenal interlobar arteries resistive index \u0026gt;0.70.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/925a014927909828293516cb.png"},{"id":51037789,"identity":"89d7bf33-2034-4c0e-9c46-517d92931795","added_by":"auto","created_at":"2024-02-13 05:48:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1629014,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3798228/v1/ace743aa-70a5-4289-8479-a0679d18ca35.pdf"}],"financialInterests":"","formattedTitle":"The use of ultrasound in assessing acute renal pain caused by pregnancy","fulltext":[{"header":"What does this study adds to clinical work","content":"\u003cp\u003e\u003cem\u003eAcute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. The purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy and guide management options using ultrasound as safe and a useful imaging modality.\u003c/em\u003e\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003e43\u0026ndash;100% of pregnant women are susceptible to hydroureteronephrosis\u003c/em\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe right side is affected in almost 85% of cases due to the gravid uterus compressing the right ureter\u003c/em\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003cem\u003eIt commences at 20 weeks of gestation and progresses as pregnancy continues, becoming more noticeable during the third trimester\u003c/em\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAcute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. It may lead to preterm delivery, premature rupture of membranes due to hazards of pain severity and frequent vomiting. Maternal systemic sepsis and acute renal injury are possible outcomes\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eMany imaging modalities can help to diagnose the cause of acute renal pain in conjunction with laboratory tests, among the imaging modalities, ultrasonography is considered safe, available and cheap diagnostic modality. The risks of radiation exposure and hazards to the foetus are associated with both computed tomography and conventional X-rays\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAlthough MRI is not readily available, it is considered an expensive imaging technique with lower sensitivity in detecting small stones\u003c/em\u003e (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eUltrasonography can help to evaluate for the cause of renal colic either obstructive or non-obstructive. It can help to localize the site of obstruction and can accurately estimate the size of stones\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eEstimating an average resistive index in the intrarenal interlobular arteries using colour Doppler can aid in the distinction between obstructive and non-obstructive uropathy\u003c/em\u003e (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe optimal way to manage the condition, whether it's surgical intervention or medical and expectant management, will hinge on the precise diagnosis and collaboration between the obstetrician and urologists. The urologist's primary goal is to save the kidney, whereas the obstetrician's primary goal is to save the pregnancy and foetus\u003c/em\u003e (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eAim of the work\u003c/b\u003e:\u003c/h2\u003e \u003cp\u003e \u003cem\u003eThe purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy among our study group using ultrasound.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Methodology","content":"\u003cp\u003e \u003cem\u003eObservational retrospective study included 87 pregnant females attended to a private ultrasound clinic, all were complaining of severe back pain, their age ranged from 18 to 38 years with the mean age being 28 years\u003c/em\u003e,\u003c/p\u003e \u003cp\u003e \u003cem\u003eTheir gestational age ranged from 7 weeks to 35 weeks, with the main gestational age being 23 weeks.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eClinical and laboratory assessments, including a complete blood picture, C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), urine analysis and culture, serum urea and creatinine levels, are conducted by the referring clinician for all.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAll were subjected to abdominal and obstetric ultrasound exams using SonoAce x8 ultrasound machine, Medison, Korea. During the period from May 2021 to December 2022.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe obstetric ultrasound examination was to accurately assess the foetus' condition, the number of foetuses, the duration of pregnancy, the location of the placenta, and the amount of liquor.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe abdominal ultrasound examination was performed to exclude hepatic masses, cysts or localized collection, to exclude gallbladder stones or inflammatory wall thickening, to exclude peripancreatic pseudocysts, and to exclude appendicitis. Both kidneys were examined to determine if there were any renal stones or hydronephrotic changes.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe degree of hydronephrosis was graded into grade1 minimal hydronephrosis, grade11 mildly dilated renal pelvis with non dilated calyces, grade111 moderately dilated renal pelvis with dilated calyces, grade 1V markedly dilated renal pelvis and calyces with attenuated parenchymal thickness\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAdditionally, to assess the thickness of the mucosal layer in the pelvicalyceal system, the turbidity of urine contents, and the degree of echogenicity in the renal parenchyma.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe echogenicity of perinephric fat planes, any perinephric collection.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe average resistive index of the interlobar and interlobular arteries was estimated using a colour duplex evaluation.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe presence of dilatation, compression or obstruction, obstruction-causing stones, and their size were assessed for both ureters.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe urinary bladder was evaluated for its wall thickness, the presence of vesical stones, and the symmetry of colour flow jets from the ureteric orifices using a power Doppler study.\u003c/em\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cem\u003eThere were 87 pregnant women who experienced acute renal pain, with 7 of them (8%) attending the exam in their first trimester, 55 of them (63%) attending the exam in their second trimester, and 25 of them (29%) attending the exam in their third trimester.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e84 patients (96.5%) presented with hydronephrotic changes and 3patients (3.5%) showed no dilation of pelvicalyceal systems, among 84 patients with hydronephrosis, the degree of hydronephrosis was grade 1 in 4 patients (4.5%), grade 11 in 7 patients (8%), grade111 in 48 patients(55%) and grade 1V in 15 patients (17%) (\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003eA,B\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe site of hydronephrotic changes was unilateral right sided in 65 patients (77%), left sided in 10 patients (12%), and bilateral in 9 patients (11%).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eRenal Pyelitis was observed in 75% of cases and was diagnosed by the combination of clinical, laboratory and ultrasound findings. Ultrasound examination showed thickening of the mucosal lining of pelvicalyceal system with turbid urine contents of the pelvicalyceal system, Right renal pyelitis was present in 55 patients (63.5%), left renal pyelitis was present in 10 patients (11.5%), and 22 patients (25%) were found to have no pyelitis. Cystitis was found in 22 patients (25%) and was diagnosed by clinical data and patient complaint of lower urinary tract irritative symptoms, pyuria in urine analysis and thickening of the urinary bladder wall\u0026thinsp;\u0026gt;\u0026thinsp;4mm in ultrasound examination Renal stones were detected in 20 patients (23%) in our study group.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eCalcular obstructive hydronephrosis was detected in 10 patients (11.5%) among them 6 patients observed with lower ureteric stones (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, B\u003cem\u003e) and 4 patients detected with renal pelviureteric junction and upper lumbar ureteric stones. (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e3\u003c/span\u003eA,B,C\u003cem\u003e).One case showed fundal uterine subserous myoma compressing the course of ureter with subsequent renal back pressure changes with an elevated intrarenal arterial average RI\u0026thinsp;=\u0026thinsp;0.75\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eRenal anomalies were incidentally observed among our study group, including 7 patients with ectopic intrapelvic kidneys, one of whom was obstructed with a pelviureteric junction stone.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAcute Pyelonephritis with no back pressure changes was detected in 3 cases, presented with acute renal pain ,fever, Bacteriuria ,elevated ESR, elevated C-reactive protein, leucocytosis. The ultrasound examination showed enlarged kidney with heterogenous texture of renal parenchyma, echogenic perinephric fat planes, and one case at 7 weeks of gestation showed an addition 2 left renal abscesses (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e) and the other 2 patients detected with right pyelonephritis observed at 22 and 35 weeks of gestation.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eAdult polycystic kidney disease was detected in 1 case at23weeks gestation showing bilateral renal sandy stones and right sided lower ureteric stone (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e5\u003c/span\u003eA,B\u003cem\u003e).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eAll obstructed cases had an elevated intra renal arterial Doppler resistive index, which ranged from 0.72 to 0.84, and the average was 0.78. (\u003c/em\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig16\" class=\"InternalRef\"\u003e6\u003c/span\u003eA,B\u003cem\u003e).No cases of non-obstructive hydronephrosis were detected with an elevated intrarenal average RI\u0026thinsp;\u0026gt;\u0026thinsp;0.70, ranging from 0.54 to 0.69.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e82 cases (94%) presented with acute renal pain were managed with expectant and medical therapy. 5 cases (6%) were managed with surgical intervention, among them 4 cases due to calcular ureteric obstruction, including 2 cases detected with lower ureteric stones and 2 cases detected with large stones at the pelviureteric junction. The size of stones was\u003c/em\u003e \u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;\u003cem\u003e8mm.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eOne case presented with acute pyelonephritis and was complicated with renal abscesses was treated through percutaneous ultrasound guided aspiration of the abscesses and appropriate antibiotic therapy.\u003c/em\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cem\u003eAccording to the present study, acute renal pain can be caused by hydroureteronephrosis, as observed in 84 cases (95.5%) in our study group. Among them, hydroureteronephrosis with secondary pyeloureteritis was observed in 65 cases (75%), renal stones were observed in 20 cases (23%), and ureteric obstruction by stones was observed in 10 cases (11.5%).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eureteric compression by uterine myoma in 1 case, a polycystic kidney disease with secondary renal stones in 1 case and acute pyelonephritis without renal back pressure changes in 3 cases.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eUltrasound can be used to assess the degree of hydronephrotic changes, to assess the size of the kidneys and the parenchymal echogenicity, to detect renal cysts or renal masses, to evaluate perinephric fat echogenicity in cases with suspected pyelonephritis and to assess the presence of perinephric collection.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eIt can follow the ureteric dilatation to the site of obstruction either with stones or ureteric compression by the gravid uterus\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eEvan et al and Butler et al reported that estimating the vascular renal resistive index was consistent with the current study. It can differentiate complete obstruction that shows an elevated estimated resistive index (RI)\u0026thinsp;\u0026gt;\u0026thinsp;0.70, as observed in all our cases with obstructive uropathy (23% of cases),and incomplete obstructive dilation caused by ureteral compression that shows normal estimated RI\u003c/em\u003e (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatient with anatomical hydroureteronephrosis was frequently involved the right side as observed in 77% of our cases more than left side as observed in 11% of our cases, in agreement with studies reported by Schulman et al and Ciciu et al, due to ureteric compression by the gravid uterus and the narrow angle of the right ureter with respect to left ureter that showed a wide angle during crossing the iliac and ovarian vessels\u003c/em\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe asymmetrical involvement of both the right and left upper urinary tracts makes it more likely to be caused by ureteric compression than a progesterone-related effect.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe ureteric compression is usually partial and incomplete, increasing as pregnancy progresses, and is more evident in the third trimester due to uterine enlargement\u003c/em\u003e (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn most cases, uterine compression caused by a gravid uterus resolves within a few weeks after delivery and can be managed medically without the need for surgical intervention\u003c/em\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe present study revealed that acute pyelitis was experienced by 75% of hydronephrosis cases. SAYLAM et al reported that in about 80% of pregnant, hydroureteronephrosis with secondary pyeloureteritis is a common issue that arises because of urinary stasis or cystitis ,leading to an ascending infection in the upper urinary tract. It can complicate surgical intervention with a ureteric stent and can also be found secondary to ureteral obstruction caused by stones\u003c/em\u003e (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eIn cases without ureteral stones, conservative management can be achieved through adequate hydration, analgesics, and antibiotic therapy, with excellent results\u003c/em\u003e (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePatients who have renal stones are prone to passing stones that obstruct the ureters due to companion pyeloureteric dilation, which is associated with pregnancy and progesterone-related ureteral muscle laxity. Renal stones can pass down to the ureter spontaneously in about 70 to 80% of cases, among them about 50% of cases will expel the stones during the postpartum period\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003cem\u003e). However, some cases may not pass the stones and require further surgical intervention.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe current study revealed that 94% of cases with acute renal pain were successfully managed with medical and expectant treatment, while only 6% were managed with surgical intervention.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePredicting surgical intervention involves ureteric stones with a size\u0026thinsp;\u0026gt;\u0026thinsp;7mm and moderate/marked pelvicalyceal dilation. Pain lasting more than 4 days and fever. Small stones less than 4mm can be treated medically and expectantly when the spontaneous passage rate reaches 50% or more\u003c/em\u003e (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eAn associated secondary pyelitis can be treated with antibiotic therapy.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePregnant females with lower urinary tract irritative symptoms should be subjected to perform urine analysis to detect pyuria and abdominal ultrasound to rule out lower ureteric stones and to assess for possible cystitis.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eTo prevent secondary upper urinary tract infections, it is important to manage cystitis adequately.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eIt's crucial for patients with acute pyelonephritis to receive antibiotic therapy that is both adequate and early to prevent complications like renal abscesses, perinephric collections that need to be drained, and to prevent systemic sepsis.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ePatients with a known history of polycystic kidney disease are more liable to develop renal stones that may pass to obstruct the ureter, therefore should be adequately followed during their pregnancy.\u003c/em\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e \u003cem\u003eTo evaluate the etiology of renal pain during pregnancy and guide management options, ultrasound is a useful and safe imaging modality. While other imaging modalities may use hazardous radiation or be expensive, it can be used reliably.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eManagement of acute renal pain with pregnancy is essential to prevent obstetric or maternal complications, it can be conservative medical and expectant in many cases, with few cases may recommend surgical intervention.\u003c/em\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConflict of interest\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: The author declares that he has no conflict interest.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: All procedures performed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (revised version of 2000) (5).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eInformed consent:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eAll patients provided written informed consent to the enrollment in the study and to the publication of information that could potentially lead to their identification.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: No funding.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Availability:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll data generated or analysed in this study were included in the article and no further data recommended to reproduce the results, however if there is any further data required, it will available on reasonable request.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFried AM, Woodring JH and Thompson DJ: Hydronephrosis of pregnancy: A prospective sequential study of the course of dilatation. J Ultrasound Med 2: 255‑259, 1983.\u003c/li\u003e\n\u003cli\u003eSchulman A and Herlinger H: Urinary tract dilatation in preg‑ Nancy. Br J Radiol 48: 638‑645, 1975\u003c/li\u003e\n\u003cli\u003eCiciu E, Paṣatu-Cornea AM, Petcu LC, Tuţă LA. Early diagnosis and management of maternal ureterohydronephrosis during pregnancy. Exp Ther Med. 2022 Jan; 23(1): 27. Do: 10.3892/etm. 2021.10949. Epub 2021 Nov 5. PMID: 34824635; PMCID: PMC8611492.\u003c/li\u003e\n\u003cli\u003eHe M, Lin X, Lei M, Xu X, He Z. The identification of pregnant women with renal colic who may need surgical intervention. BMC Urol. 2022 Mar 7;22(1): 30. Do: 10.1186/s12894-022-00985-x. PMID: 35255882; PMCID: PMC8903555.\u003c/li\u003e\n\u003cli\u003eMacNeily AE, Goldenberg SL, Allen GJ, Ajzen SA and Cooperberg PL: Sonographic visualization of the ureter in pregnancy. J Urol 146: 298‑301, 1991.\u003c/li\u003e\n\u003cli\u003eEvans HJ, Wollin TA. The management of urinary calculi in pregnancy. CurrOpin Urol. 2001; 11: 379-384.\u003c/li\u003e\n\u003cli\u003eButler EL, Cox SM, Eberts EG, Cunningham FG. Symptomatic Nephrolithiasis Complicating Pregnancy. Obstet Gynecol. 2000;96 (5 Pt 1): 753\u0026ndash;756. [PubMed] [Google Scholar].\u003c/li\u003e\n\u003cli\u003eBlanco LT, Socarras MR, Montero RF, Diez EL, Calvo AO, Gregorio SAY, Cansino JR, Galan JA, Rivas JG. Renal colic during pregnancy: Diagnostic and therapeutic aspects. Literature review. Cent European J Urol. 2017;70(1):93-100. Do: 10.5173/ceju. 2017.754. Epub 2016 Oct 28. PMID: 28461996; PMCID: PMC5407324. \u003c/li\u003e\n\u003cli\u003eFainaru O, Almog B, Gamzu R et-al. The management of symptomatic hydronephrosis in pregnancy. BJOG. 2002;109 (12): 1385-7.\u003c/li\u003e\n\u003cli\u003eSAYLAM B, EFESOY A, ERDEM E. Clinical Course of Pregnant Women with Maternal Hydronephrosis: Retrospective Clinical Study. Duzce Med J. August 2021;23(2):170-173. doi:10.18678/dtfd.917116\u003c/li\u003e\n\u003cli\u003eLoh K, Sivalingam N. Urinary tract infections in pregnancy. Malays Fam Physician. 2007 Aug 31;2(2): 54-7. PMID: 25606081; PMCID: PMC4170332.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy, Acute renal pain, Hydronephrosis, Ultrasonography","lastPublishedDoi":"10.21203/rs.3.rs-3798228/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3798228/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: Acute renal pain or renal colic is an abdominal emergency that can occur during pregnancy and have severe maternal and foetal adverse effects. Ultrasonography can help to evaluate for the cause of renal pain either obstructive or non-obstructive. It can help to localize the site of obstruction and can accurately estimate the size of stones.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAim of the work\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e: The purpose of this study was to evaluate and assess the prevalence of various etiologies that could lead to acute renal pain during pregnancy among our study group using ultrasound.\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e\u003c/em\u003e\u003cem\u003eObservational retrospective study in which 87 pregnant females attended to a private ultrasound clinic, all were complaining of severe back pain, their age ranged from 18 to 38 years with the mean age being 28 years. All were subjected to abdominal and obstetric ultrasound exams in addition to clinical and laboratory evaluation.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults: \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThere were 87 pregnant women who experienced acute renal pain. 84 patients presented with hydronephrotic changes and 3 patients showed no dilation of pelvicalyceal systems. Among them hydroureteronephrosis with secondary pyeloureteritis observed in 65cases (75%). Renal stones were detected in 22 cases and 1 case was detected with adult polycystic kidney disease.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion \u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:To evaluate the etiology of renal pain during pregnancy and guide management options, ultrasound is a useful and safe imaging modality. Management of acute renal pain with pregnancy is essential to prevent obstetric or maternal complications, it can be conservative medical and expectant in many cases, with few cases may recommend surgical intervention.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"The use of ultrasound in assessing acute renal pain caused by pregnancy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-01 10:58:07","doi":"10.21203/rs.3.rs-3798228/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3c4e880-36bc-442b-87eb-e9d1546c30af","owner":[],"postedDate":"January 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-13T05:40:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-01 10:58:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3798228","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3798228","identity":"rs-3798228","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}