Symptomatic hydronephrosis in pregnancy: a case series and literature review. Is bigger always better?

Abstract

Introduction: Hydronephrosis is common in pregnancy affecting a vast majority of women. Most of the cases of symptomatic hydronephrosis in pregnancy resolve with conservative measures with a rare need for surgical management with stent insertion.

Objectives: We present a case series of 4 cases of pregnancies complicated with hydronephrosis outlining clinical presentation, diagnostic workup and subsequent management and outcomes. Subsequently we undertake a literature review to assess the body of evidence on symptomatic hydronephrosis in pregnancy focusing on its clinical course and indicators for non-conservative measures of management.

Conclusion: The cases presented concur that symptomatic hydronephrosis is a rare complication in pregnancy that mostly responds well with conservative measures. However, it should be suspected in a pregnant lady presenting with non resolving unilateral flank pain. Early diagnosis and treatment may impact on the prevention of subsequent pyelonephritis. Ultrasound examination usually suffices for diagnosis but renal resistive indices and renal functions may guide on whether one requires a conservative approach or stenting to improve renal outcomes.

Keywords: Hydronephrosis, Pregnancy, Symptomatic