Case 26 - A 30-Year-Old at 18 Weeks’ Gestation with Fever, Dysuria, Worsening Flank Pain, and Hydronephrosis

Summary

Hydronephrosis and hydroureter, characterized by renal collecting system enlargement and ureteral distention, are common occurrences in pregnancy, affecting around 80% of pregnant individuals, more often prevalent on the right side. Detection through ultrasound usually occurs in the second or third trimester, resolving within 6 weeks postpartum. Compression of ureters by the uterus against the pelvic brim, compounded by hormonal effects, primarily contributes to hydroureter and hydronephrosis. While typically asymptomatic, stasis of urine increases the risk of pyelonephritis and preterm delivery. Distinguishing physiological and pathological dilatation remains debated. In rare cases, severe obstruction can cause acute hydronephrosis. Management focuses on conservative measures, fluid intake, pain relief, and addressing bacteriuria to prevent pyelonephritis. Procedural intervention is rarely necessary. However, if pathological factors like nephrolithiasis cause acute obstruction, prompt intervention may be needed.