Spontaneous renal fornix rupture in pregnancy and the post partum period: a systematic review of outcomes and management

A Spontaneous Renal Calyceal Rupture Mimicking Physiologic Changes of Pregnancy and Other Common Pathologies

A spontaneous renal calyceal rupture in pregnancy is extremely rare and can be challenging to identify as its presentation can mimic other more common diagnoses, which can lead to a delay in management. Here, we describe an unusual case of renal calyceal rupture in a 24-year-old G2P0010 female with pregnancy at 26.5 weeks gestation age (WGA) who was admitted to the antepartum ward due to left flank pain and uterine contractions. A renal sonogram was performed, which revealed severe left hydronephrosis and the absence of the ipsilateral ureteral jet. Urinalysis was within normal limits, and her renal function was preserved. Laboratories were remarkable for elevated liver enzymes. Finally, an abdominopelvic MRI revealed the culprit, a calyceal rupture. Once the diagnosis was clear, a double J-stent was inserted using limited fluoroscopy with the goal of reducing intrarenal pressure and decreasing disease morbidity. The patient's symptoms significantly improved after double J-stent placement and resolved the following day. The patient further developed preeclampsia with severe features, which has previously been documented to occur in pregnant patients with renal tract ruptures. The diagnosis of a renal calyceal rupture in pregnancy is not straightforward, in part because of a lack of awareness of this pathology. Nevertheless, early identification can prevent unnecessary interventions and adverse outcomes. Its diagnosis can be made with MRI, and its management with ureteral stent placement shouldn't be delayed, and its association with preeclampsia should be further explored.

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

Importance

Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.

Objective

This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.

Evidence Acquisition

A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.

Results

The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.

Conclusions

When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.

Relevance

Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.