We had a good discussion today looking at the approach to renal failure (previous blog here) in pregnancy.
It is important to note that the correlation between flank pain in pregnancy and hydronephrosis is tenuous. In cases of obstruction, MRI can be useful in differentiating between physiologic and calculi obstruction with no radiation risk. In the absence of recurring infection, renal failure, intractable pain, these patients can be managed expectantly (reference).
Our patient had renal failure. The cause in this case (as evidenced by the rapid reversal after insertion of bilateral nephrostomy tubes) was obstructive, possibly related to the presence of large fibroids. A similar case has been published here. A review article on obstructive uropathy in pregnancy is here.
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