How Are Kidney Stones Treated During Pregnancy? Expert Explains Treatment, Risks, and What to Expect

Kidney stones are painful enough on their own, but when they develop during pregnancy, treatment becomes a lot more complicated. Doctors can't just use the same scans and medication, as the safety of the baby has to be paramount at all times. This sometimes makes pregnant women wonder how stones are even diagnosed, let alone treated, without compromising the pregnancy. 

Fortunately, most cases can be safely managed with the proper monitoring and careful approach. We spoke to Dr Arpit Srivastava, Consultant Nephrologist, Regency Hospital, Gorakhpur, to understand exactly how this works.

What Is the First Approach to Treating Kidney Stones in Pregnancy?

Dr Arpit explains that treatment during pregnancy leans heavily towards the conservative side, especially compared to how stones are usually managed.

He shares that the first line of action typically includes:

• Pain management
• Hydration
• Close monitoring through ultrasound, rather than CT scans

This shift towards ultrasound is deliberate. As Dr Arpit notes, doctors avoid radiation exposure as much as possible during pregnancy, which rules out CT scans as a routine diagnostic tool. He adds that most small stones are managed this way and pass on their own without further intervention.

However, when a stone is large, causing severe pain, or blocking urine flow, more active steps become necessary. In such cases, Dr Arpit explains that a stent or a nephrostomy tube may be placed to relieve the obstruction, with more definitive treatment usually planned for after delivery.

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How Is Treating Kidney Stones in Pregnancy Different From Regular Cases?

According to Dr Arpit, pregnancy genuinely makes things more difficult, and not just slightly so. In a non-pregnant patient, he points out that doctors have considerably more tools at their disposal, including CT scans for accurate diagnosis, a broader range of medications, and procedures like lithotripsy or ureteroscopy whenever required.

During pregnancy, though, several of these options become limited or unsafe. Dr Arpit explains that imaging choices are restricted, many common pain medications can't be used, and any procedure carries an added layer of risk for the baby. As he puts it, doctors are essentially "treating the same problem with one hand tied behind our back," which makes the timing and judgement involved far more critical than usual.

Treatment is usually cautious and approached step-by-step. According to a 2020 clinical review published in Current Urology Reports, ultrasound is the recommended first-choice imaging method, since doctors try to avoid radiation exposure to the baby wherever possible. Most small stones pass naturally with fluids and safe pain relief. If the situation is more serious, such as infection or blockage, urgent drainage may be needed, often through a temporary nephrostomy tube.

Can Kidney Stones Develop at Any Stage of Pregnancy?

Yes, Dr Arpit says, kidney stones can happen in all trimesters, but are more common in the second and third trimesters.

This is due to natural changes which occur in the body during pregnancy, he explains. The ureters dilate with the hormonal changes, as well as the uterus pressing on them. This slows down the flow of urine and makes stones more common later in pregnancy.

Interestingly, Dr Arpit says that the fundamental mode of treatment doesn't vary significantly based on trimester. The imaging methods and the willingness of doctors to intervene surgically are what change. The attitude during early pregnancy is generally more conservative. In the second trimester, when the situation is absolutely necessary, doctors can be more certain in performing the more definite procedures.

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Can Kidney Stones Affect the Mother and the Baby?

This is understandably one of the biggest concerns for expectant mothers, and Dr Arpit is clear that the risks are real if a stone is left untreated.

For the mother, he explains that an obstructing stone can lead to:

• Infection
• Severe pain
• Preterm labour, in some cases

What he adds here is equally important: Pregnancy itself alters the response to infection, and if an infection is not controlled, things can quickly spiral out of control.

Dr Arpit says that for the baby, risks most often occur in an indirect manner. These may be due to the mother's infection, or due to early contractions, or, in rare cases, a stress reaction to uncontrolled pain and dehydration. That's why, in his words, doctors "don't wait and watch for too long if symptoms are substantial.

As per a 2022 Current Urology Report, kidney stone disease, affecting roughly 1% of pregnancies, significantly increases risks of pyelonephritis, miscarriage, premature birth, and conditions like pre-eclampsia. Mothers experiencing these stones face a 12.5% recurrence rate postpartum, while prior pregnancy is linked to a doubled risk of future stone development.

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What Are the Treatment Options for Kidney Stones During Pregnancy?

Dr Arpit outlines a fairly structured approach to managing kidney stones safely throughout pregnancy.

The initial steps usually involve:

• Hydration
• Pregnancy-safe pain relief
• Close monitoring

If the stone doesn't go away on its own and if there is still pain, infection or blockage, doctors take a step toward temporary solutions. This is frequently done by inserting a double-J stent or nephrostomy tube to prevent the kidney from filling up until the problem resolves, says Dr Arpit.

When it comes to permanent removal of stones, Dr Arpit says that it is typically postponed after delivery. In cases that become urgent, however, ureteroscopy can be done carefully, preferably in the second trimester of pregnancy, and should only be done by an experienced team in which the patient management of such cases during pregnancy is well understood.