Clinical Course of Pregnant Women with Maternal Hydronephrosis: Retrospective Clinical Study

Yıl 2021, Cilt: 23 Sayı: 2, 170 - 173, 30.08.2021

Barış Saylam , Aysun Efesoy Erim Erdem

https://doi.org/10.18678/dtfd.917116

Cited By: 1

Öz

Aim: The study aims to investigate the clinical course of symptomatic physiological hydronephrosis in pregnant women and the results of treatment in patients required treatment.
Material and Methods: A hundred and two consecutive pregnant women who presented with clinical signs and symptoms related to the upper urinary system were included in the study. Renal ultrasonography, urinalysis, serum creatinine levels, white blood cell count, and urine culture were done in all patients at the first visit and repeated at least once a month until 1 month after delivery. In patients with acute pyelonephritis, urinalysis was repeated every 3 days until white blood cell count, erythrocyte sedimentation rate and C-reactive protein levels normalized; urine culture and kidney ultrasonography were performed monthly until 1 month after delivery. Conservative measures (positioning, analgesia, antibiotics) were used in all patients with symptomatic physiological hydronephrosis. If the patient's condition was resistant to medical treatment and the degree of hydronephrosis was increased, drainage was performed by inserting a double J stent into the ureter.
Results: Conservative treatments were successful in 98 (96.1%) of 102 patients, but 4 (3.9%) had signs and symptoms of acute pyelonephritis progressing to urosepsis. Antibiotics were continued in patients who developed pyelonephritis, symptoms regressed rapidly, signs of kidney infection returned to normal. Follow-up pregnancies ended with normal vaginal delivery.
Conclusion: Symptomatic hydronephrosis in pregnancy can be treated conservatively, should be treated carefully and patients should be followed up. However, ureteral double-J stenting is an effective and safe treatment method in patients with resistant symptoms.

Anahtar Kelimeler

Hydronephrosis, pregnancy, renal ultrasonography

Maternal Hidronefrozlu Gebe Kadınların Klinik Seyri: Retrospektif Klinik Çalışma

Öz

Amaç: Bu çalışmanın amacı gebe kadınlarda semptomatik fizyolojik hidronefrozun klinik seyrinin ve tedavi gereken hastalarda tedavi sonuçlarının araştırılmasıdır.
Gereç ve Yöntemler: Üst üriner sistem ile ilgili klinik belirti ve semptomlarla başvuran ardışık 102 gebe kadın çalışmaya dahil edilmiştir. Tüm hastalarda ilk vizitte renal ultrasonografi, idrar tahlili, serum kreatinin düzeyi, beyaz kan hücresi sayımı ve idrar kültürü yapıldı, doğumdan 1 ay sonrasına kadar ayda en az bir kez tekrarlandı. Akut piyelonefritli hastalarda idrar tahlili, beyaz kan hücresi sayısı, eritrosit sedimantasyon hızı ve C-reaktif protein seviyeleri normalleşene kadar her 3 günde bir tekrarlandı; idrar kültürü ve böbrek ultrasonografisi doğumdan 1 ay sonrasına kadar ayda bir kez yapıldı. Semptomatik fizyolojik hidronefrozlu tüm hastalarda konservatif önlemler (pozisyon verme, analjezi, antibiyotikler) uygulandı. Hastanın durumu tıbbi tedaviye dirençli ve hidronefroz derecesinde artış var ise, üretere double J stent takılarak drenaj yapıldı.
Bulgular: Konservatif tedaviler 102 hastanın 98’inde (%96,1) başarılıydı, ancak 4’ünde (%3,9) ürosepsiye ilerleyen akut piyelonefrit belirtileri ve semptomları vardı. Pyelonefrit gelişen hastalarda antibiyotiklere devam edildi ve semptomları hızlı bir şekilde geriledi, böbrek enfeksiyonunun bulguları normale döndü. Takip edilen gebelikler normal vajinal doğum ile sonlandı.
Sonuç: Gebelikte semptomatik hidronefroz konservatif olarak tedavi edilebilir, dikkatli bir şekilde tedavi edilmeli ve hastalar takip edilmelidir. Bununla birlikte dirençli semptomları olan hastalarda ureteral double-J stent takılması etkili ve güvenli bir tedavi yöntemdir.

Anahtar Kelimeler

hidronefroz, gebelik, renal ultrasonografi

Kaynakça

• Ercil H, Arslan B, Ortoglu F, Alma E, Unal U, Deniz M, et al. Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study. Int Urol Nephrol. 2017;49(8):1347-52.
• Coban S, Biyik I, Ustunyurt E, Keles I, Guzelsoy M, Demirci H. Is there a relationship between the grade of maternal hydronephrosis and birth weight of the babies? J Matern Fetal Neonatal Med. 2015;28(9):1053-6.
• Watson WJ, Brost BC. Maternal hydronephrosis in pregnancy: poor association with symptoms of flank pain. Am J Perinatol. 2006;23(8):463-6.
• Farr A, Ott J, Kueronya V, Margreiter M, Javadli E, Einig S, et al. The association between maternal hydronephrosis and acute flank pain during pregnancy: a prospective pilot-study. J Matern Fetal Neonatal Med. 2017;30(20):2417-21.
• Choi CI, Yu YD, Park DS. Ureteral stent insertion in the management of renal colic during pregnancy. Chonnam Med J. 2016;52(2):123-7.
• Tsai YL, Seow KM, Yieh CH, Chong KM, Hwang JL, Lin YH, et al. Comparative study of conservative and surgical management for symptomatic moderate and severe hydronephrosis in pregnancy: a prospective randomized study. Acta Obstet Gynecol Scand. 2007;86(9):1047-50.
• Zwergel T, Lindenmeir T, Wullich B. Management of acute hydronephrosis in pregnancy by ureteral stenting. Eur Urol. 1996;29(3):292-7.
• Puskar D, Balagović I, Filipović A, Knezović N, Kopjar M, Huis M, et al. Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment. Eur Urol. 2001;39(3):260-3.
• Delakas D, Karyotis I, Loumbakis P, Daskalopoulos G, Kazanis J, Cranidis A. Ureteral drainage by double-J-catheters during pregnancy. Clin Exp Obstet Gynecol. 2000;27(3-4):200-2.
• Wymer K, Plunkett BA, Park S. Urolithiasis in pregnancy: a cost-effectiveness analysis of ureteroscopic management vs ureteral stenting. Am J Obstet Gynecol. 2015;213(5):691.e1-8.
• Quinn AD, Kusuda L, Amar AD, Das S. Percutaneous nephrostomy for treatment of hydronephrosis of pregnancy. J Urol. 1988;139(5):1037-8.
• vanSonnenberg E, Casola G, Talner LB, Wittich GR, Varney RR, D’Agostino HB. Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy. Am J Roentgenol. 1992;158(1):91-4.