What You Need to Know About Kidney Stones in Pregnancy

It turns out I spoke too soon and ended up with another hospital trip over the weekend.
But, as promised, I’m going to put the past month and a half’s worth of hospital visits, doctor’s notes and NHS time to good use.

When I was initially diagnosed with kidney trouble: renal colic and potential kidney stones on 1st June, I did what many of us with internet access do and started to research online the condition, medication and potential impact on my pregnancy. Whilst NHS Choices (UK) and the National Kidney Foundation (USA) provide detailed explanations of what kidney stones are, how they form, treatment options and comprehensive lists of symptoms, they have little relating specifically to pregnancy.

The reason it is so hard to find out about kidney stones in pregnancy is because they don’t occur frequently enough to be classified as part of a ‘normal‘ pregnancy (which, by the way, does not exist). Most online information revolves around prevention, which is great, as the famous Benjamin Franklin quote says: ‘an ounce of prevention is worth a pound of cure’. But we pregnant women already pile huge amounts of blame and pressure on ourselves regarding what we are doing and experiencing throughout gestation and reading that drinking more water might have prevented this current agony does not help. Besides, in pregnancy, kidney stones are about more than mere hydration.

My online research wasn’t giving me much so I wanted to convert the oral information given to me at the numerous appointments with obstetricians, general practitioners and urologists into a post for the benefit of others.

Why Does Pregnancy Make You More Susceptible to Kidney Stones?

Hydration is of course important at all times and during pregnancy a woman’s body does require more fluid for the changes and creations that are occurring. These changes result in the body working harder, including the kidneys.

1. Increased blood volume during pregnancy means increased filtration for your kidneys as they work to remove waste and return nutrients. With increased water consumption the kidneys ideally have enough fluid to filter effectively and prevent the crystallisation of minerals within the organ which can develop into kidney stones. Yet increased blood volume equates to more work and there are more minerals to filter.

2. There are several different types of kidney stone, the most common being composed of crystallised calcium. In addition to increased blood volume during pregnancy, there is also more calcium in your blood because of the developing fetus. Not only is your body absorbing more calcium during pregnancy, but your kidneys are also extracting more, potentially leading to an increased build up of this mineral either as crystals or, eventually, as stones.

3. In addition to your kidneys working harder for you with increased blood volume and calcium extraction, they are also working for your baby. Although the major organs are formed early on in gestation, the fetus still has no kidney function of its own until 10 weeks. At this time your baby begins to drink from the amniotic fluid surrounding it, produce urine and replenish the amniotic sac.

4. However, despite babies having their own kidneys from 10 weeks onwards, you body is still doing a lot of the work until the very last stages of pregnancy. Although the fetus is producing urine, there is still plenty of waste, excess water and other substances transferred between mum and baby via the umbilical cord. It is mum’s kidneys that are then filtering and extracting these extra materials prolonging their increased workload.

5. As with many medical conditions kidney stones have a tendency to reoccur. If you have had kidney stones in the past you have an increased chance of developing them again, especially during the extra strain of pregnancy.

Should You Worry?

I experienced a brief lull and calm after receiving a diagnosis. However, it didn’t last long as although I now had some comfort from what was causing the extreme pain I was experiencing, my thoughts turned immediately to what this might mean for my unborn child.

This was what fuelled my initial online search for information about kidney stones. Typing kidney stones and pregnancy into a search engine can result in some pretty concerning, yet entirely unrelated, findings. Predominately, the results generated will be to do with kidney infections, kidney failure or urinary tract infections. In comparison, kidney stones are not something to fret about. They can be incredibly painful, but it is mainly an issue that affects mum as opposed to baby. The main problems from kidney stones result from pregnancy rather than the other way around.

1. As I have detailed in another post dedicated to medication, there are very few pain management options available during pregnancy. It is usually this, rather than the condition, that results in the increased rates of hospitalisation for pregnant women with kidney stones, not the stones themselves.

2. Usually, kidney stones are left largely to their own devices. This should immediately reduce the rate of alarm because if there were risks to the fetus you can guarantee that there would be very swift action taken (as there would be in the case of infection). Whilst it is far from a pleasant experience, most stones are small enough to pass on their own.

Particularly large stones can cause blockages and then interventions will be investigated. Treatment of kidney stones is complicated by pregnancy as the most accurate method of detecting them is x-ray, which of course will not be used on an expectant mother. Some doctors believe that the risks are negligible but this is a conversation that you would need to have with the consultant or urologist. Ultrasound is the alternative and is still very accurate for detecting large stones, or their presence if the kidney is swollen or puffy.

In the case of blockage or infection (as with urinary tract infections which can be delightfully frequent in pregnancy) there can be a risk to your baby if your temperature rises or a fever develops for a prolonged period. It is always advised that you contact your health professional in the case of developing a temperature, whatever the cause.

Treatment

In these cases treatment appears to be the same for both pregnant and non-pregnant patients. Ultrasound waves may be used to break down the stone (given the much more alarming treatment term of extracorporeal shock wave lithotripsy – eek!) or surgery. Today, it is rare for open surgery to be performed with a ureteroscopy being the more likely.

Antibiotics will be used to treat infection, opening up an entirely different set of decisions for pregnant women and their healthcare providers. As with pain management the options are limited and it may be decided to administer them in hospital rather than with a take home prescription.

As usual, this post carries the disclaimer that I have no medical training and that any symptoms that are causing concern should be discussed with a health professional and not self-diagnosed on the internet. This post is intended to compile information and highlight options, not to advise.

Advertisements

Medical Update

Friday 13th is perhaps not the most reassuring date for a hospital visit.

I am so grateful for the NHS and medical teams in Scotland. At all my many hospital trips over the past few months the nurses and doctors have been attentive, listened and smiled.

This year celebrates 70 years of the NHS, providing free healthcare to the entire UK. There are funding, staffing and overtime issues, but we are better off with it than without and it is so important to remember all the medical staff who work so hard and such long hours to keep it going. I felt I had to give them a heartfelt mention.

Today’s Update

If there ever was a kidney stone, there certainly isn’t one now.

Thankfully I have had no flank pain for almost a month, and the ultrasound scan two weeks ago showed no swelling and all blood and urine tests have been clear of infection.

The suggestion currently is that baby is lying on a nerve or some other vessel which is what causes the sporadic cramping when I urinate.

Whether baby is responsible for the constant abdominal pain that was perplexing doctors 4 weeks ago is something I am still doubtful about. He would have had to have been lying on the same place for an awfully long time to generate such continual severe pain. (I know he doesn’t stay in the same place for long as, since I have started to feel his movements, I can feel him wriggle around in accordance to the flares up of cramping I am experiencing).

A nurse did scan my bladder and found a little retained fluid, but the doctor explained that the machine can pick up amniotic fluid by mistake. So essentially there is fluid in my abdomen which may or may not be meant to be there…

Fun Facts

As ever though, with each appointment a little more knowledge and understanding is gleaned.

Although you won’t find much information out there about kidney stones in pregnancy (I hope to post up something shortly to rectify this) there is a trend between pregnancy and kidney stones because:

1: your body produces more blood so you kidneys are filtering a higher quantity than usual.

2: more calcium is passing through your kidneys, increasing the possibility of it crystallising and forming a stone.

3: in addition to your kidneys working extra for you they are also working for baby for the first 10 weeks as the fetus has no kidneys of its own at that time.

We all know how important hydration is, especially in pregnancy but it really is the most effective prevention against developing kidney stones.

I also learned a fun fact about kidney ultrasounds today (you can see I have had too many appointments as I am now describing this information as ‘fun’).

I mentioned in a previous post about that ultrasound is considered less effective but of course considerably safer during pregnancy than x-rays. Today the doctor inform me that the ultrasound scan is 90% effective and that what the sonographer is aiming to identify is any swelling or puffiness of the kidney itself, or any signs of blockage within the tubes connecting the kidneys and bladder.

As long as there is no blockage, kidney stones will be left to pass by themselves (I have a whole post on pain management during pregnancy which you can find here) which is usual treatment for kidney stones in non-pregnant patients as well (although they have more options for pain management). It is soley down to pain management that leads to the hospalisation of pregnant women with kidney stones.

If stones are particularly large, there is swelling or a potential blockage, urologists will consider treatment. Ultrasound may be used to break up the stone or surgery may be considered.

The doctor today mentioned (to my surprise) that had swelling been detected at the ultrasound the temple would have considered an x-ray and that the risk to my unborn child is negligible… bearing in mind that I am a completely untrained with no medical background whatsoever… I’m not convinced by that, especially given the information from other doctors I have seen. But I do imagine that there may be extreme circumstances where the risk to mum not having the procedure may be more than the risk the procedure holds for baby.

Conclusions

The matter seems to be put to bed for the time being. We can move forward with the confidence and reassurance that both baby and I are healthy and that everything is functioning as it should.

Now I can relax, hope baby stops elbowing my bladder or whatever he’s doing to cause this periodic cramping and just enjoy the rest of my pregnancy (despite the unabating nausea…).

Disclaimer: I am not a medical professional. I am just relaying personal experience and the information that has been given to me by doctors, nurses and that I have uncovered through my own research. As I could find very little online when I first started this unpleasant process I hope that by creating these posts I might be able to assist somebody else. 

 

Medication in Pregnancy

I thought it was about time I put all these hospital visits to good use. I have now been prescribed pretty much everything you can be prescribed for pain during pregnancy (in the UK), and had numerous doctors explain to me what medications I can and cannot take.

I hope that this post will help you gain a little more information about medications during your pregnancy experience and reduce the amount of scrolling through the world-wide web.

This post covers Paracetamol, Ibuprofen, Codeine and Co-codamol.

Where This Post Began

For those of you who have been following my pregnancy journey, you will know that 3 weeks ago I was in the Out of Hours clinic at the hospital, and then the maternity unit in the next town. This resulted in a diagnosis of renal colic, likely resulting from a kidney stone.

I discussed how pregnant women can become more susceptible to kidney stones (although there is no increased risk associaed with pregnancy) because of the extra pressure all your organs undergo during gestation.

Kidney stones can take a while to pass by themselves and treatment, both of the stone and of the accompanying pain, are limited during pregnancy. X-rays are the most reliable screening test (although ultrasound can be used with mixed results), but of course radiation would never be used anywhere near a developing fetus.

Pain Relief: Paracetamol, Codeine and Co-codamol

Due to the extreme agony of renal colic and the limited options for pain relief in pregnancy (under usual circumstances Paracetamol is the maximum and then recommended to be used as little as possible), it is very common for women to be admitted to hospital if they develop stones during pregnancy.

Medications containing Codeine should only be used under  prescription during pregnancy because it contains opiates, and should not be taken at all during the first and third trimesters as it is during these developmental stages that baby will be most effected by its use.

I was prescribed Co-codamol (which combines Codeine and Paracetamol) because if you have ever had renal colic you will be aware that regular painkillers just don’t touch it.

Unfortunately, I did not react well to these tablets (and to be perfectly  honest was not keen on taking even prescribed medication with opiates in it). They made me dizzy, disoriented and extremely nauseous. They numbed the pain beautifully, but made me completely disfunctional.

When you react negatively to Co-codamol, you just plain react badly to it. Attempts to reduce the dosage and prescriptions of straight Codeine, are unlikely to have any different results.

What are Your Alternatives? 

Whilst the tablets reduced the pain  enough for me to deliver walking tours, the side effects would have made me a health and safety nightmare. With my additional reluctance over what the tablets contained, I stopped taking them and headed off to the doctor.

She prescribed just straight Paracetamol and told me that to make it effective, I would need to keep on taking it every 4 to 6 hour. As you will note from the link above, this is not ideal.

Ibuprofen should also always be taken with care, not for prolonged periods, and is ideally completely avoided during pregnancy.

So in answer to the initial question, there are very few alternative options.

When (as in this instance) screening tests make you certain that the pain is not related to baby (always a relief to any expecting parent) it is the case that the pain is not a complication of the pregnancy, but that treatment of the cause is complicated because of the pregnancy.

Personal Update and Notes on Buscopan

This was my final alternative for the pain I was experiencing. For two weeks following the initial hospital visit, the pain became gradually less severe and to my relief I was able to manage it without going near Codeine.

But last week, suddenly the pain spiked once again and rather than occurring centrally, moved around to my back, concerning me that it was kidney related. Once again, we ended up with a midnight trip to hospital, numerous blood tests and multiple medical opinions.

There seemed to be some surprise that I had received the diagnosis of kidney stones without any screening tests (as I mentioned above, you won’t be x-rayed during pregnancy due to radiation, but ultrasounds can be used, although they are less effective in this area).  Currently, I have been re-diagnosed with constant, considerable abdominal pain of unknown cause.

After a lengthy but pleasant discussion with the doctor, there was one final painkiller we could try, Buscopan. This was because of the new conclusion that the pain wasn’t renal and the guess was that perhaps it could be bowel related.

Buscopan is usually used to treat conditions such as irritable bowel syndrome (IBS), menstrual cramping and other forms of cramps and internal spasms. For the majority, it has no side effects making it a suitable alternative for those who react negatively to Codeine. There is, however, a very long list of instances in which you should not take Buscopan, and like Ibuprofen it is not a solution for long term pain relief.

Where We Are at Present

Ultimately, it is feasible that 3 weeks ago when the first round of hospital trips and tests began, I did have something (the professional jury still seems to be out as to whether it was a stone or not) irritating my kidneys, but although I am still experiencing considerable abdominal discomfort, it is now unlikely to be kidney related.

I am relieved, kidneys are vital organs and no one wants there to be something wrong with them. Whilst it is daunting to be experiencing unexplained abdominal pain, it is reassuring to know that all the blood tests have come back clear, showing that the kidneys are functioning properly. These blood tests also indicate that there is not infection or inflammation, which suggests that if there was a kidney stone, it is not the cause of this current pain and that it isn’t a urinary tract infection (UTI) or anything else too be overly worried about.

This is good news because it is when these (otherwise unrelated conditions) result in infections or fevers that they can start to impact the developing fetus.

I can gain comfort from a referral to get an ultrasound scan on my kidneys next week. 

As ever, if you are experiencing any medical concerns, always seek professional assistance.