Renal colic is an acute pain attack caused by a sudden violation of the passage of urine, an increase in intracranial pressure. It is characterized by pronounced cramping pains in the lower back, spreading down the ureter, frequent and painful urination, nausea and vomiting, psychomotor agitation. Relief of the attack is carried out with the help of local heat, the introduction of antispasmodics and analgesics (up to narcotic), novocaine blockades. To determine the cause of renal colic, urine examination, intravenous urography, chromocystoscopy, ultrasound, CT of the kidneys are performed.
ICD 10
N23 Renal colic
Meaning
Renal colic can complicate the course of a number of diseases of the urinary tract. In clinical urology, it is regarded as an urgent condition that requires the speedy removal of acute pain and normalization of kidney functioning. It is considered the most common syndrome in the structure of urinary tract pathologies. It is most often provoked by urolithiasis. With the location of the stone in the kidney, colic occurs in half of the patients, with localization in the ureter – in 95-98%.
Causes
The development of renal colic is associated with a sudden violation of urine drainage from the kidney due to internal blockage or external compression of the urinary tract. This condition is accompanied by reflex spastic contraction of the ureter musculature, increased hydrostatic pressure inside the pelvis, venous stasis, parenchymal edema and overgrowth of the fibrous capsule of the kidney. Due to irritation of sensitive receptors, a sudden and pronounced pain syndrome develops – renal colic.
The immediate causes of renal colic can be:
- Mechanical obstacles that disrupt the passage of urine from the renal pelvis or ureter. In most cases (57.5%), the condition occurs when the concretion is infringed in any part of the ureter with urolithiasis. Sometimes obstruction of the ureter is caused by clots of mucus or pus in pyelonephritis, caseous masses or rejected necrotic papillae in kidney tuberculosis.
- Inflection or twisting of the ureter. Occurs with nephroptosis, kidney dystopia, ureter strictures.
- External compression of the urinary tract. Compression is often caused by tumors of the kidneys (papillary adenocarcinoma, etc.), ureter, prostate gland (prostate adenoma, prostate cancer); retroperitoneal and subcapsular posttraumatic hematomas (including, after remote lithotripsy).
- Inflammatory diseases. Acute pain attacks often occur with hydronephrosis, acute segmental edema of the mucosa with periurethritis, urethritis, prostatitis.
- Vascular pathologies. The development of renal colic is possible with phlebostasis in the venous system of the pelvis, renal vein thrombosis.
- Congenital anomalies of the kidneys. Urodynamic disorders accompanied by colic occur with achalasia, dyskinesia, megacalicosis, spongy kidney, etc.
Renal colic symptoms
A classic sign is sudden, intense, cramping pain in the lumbar region or the rib-vertebral angle. A painful attack can develop at night, during sleep; sometimes patients associate the onset of colic with physical exertion, jolting driving, prolonged walking, taking diuretic medications or a large volume of fluid.
From the lower back, pain can spread to the mesogastric, iliac region, thigh, rectum; in men – to the penis and scrotum, in women – to the labia and perineum. A painful attack can last from 3 to 18 hours or more; at the same time, the intensity of pain, its localization and irradiation may vary. Patients are restless, rushing, do not find a position that relieves pain.
Frequent urge to urinate develops, in the future – oliguria or anuria, urethral pains, dry mouth, vomiting, tenesmus, flatulence. Moderate hypertension, tachycardia, subfebrility, chills are noted. Severe pain can cause a state of shock (hypotension, pallor of the skin, bradycardia, cold sweat). After the end of renal colic, a significant amount of urine is usually released, in which micro- or macrohematuria is detected.
Diagnostics
When recognizing renal colic, anamnesis, objective picture data and instrumental studies are guided. The corresponding half of the lumbar region is painful on palpation, the symptom of beating along the costal arch is sharply positive. Examination of urine after the pain attack subsides makes it possible to detect fresh red blood cells or blood clots, protein, salts, leukocytes, epithelium. To confirm the diagnosis of ICD , the following is performed:
- X-ray diagnostics. An overview radiography of the abdominal cavity makes it possible to exclude acute abdominal pathology. In addition, on radiographs and urograms, intestinal pneumatosis, a denser shadow of the affected kidney and a “halo of rarefaction” in the area of the parotid tissues with their edema can be detected. Conducting intravenous urography to change the contours of the cups and pelvis, kidney displacement, the nature of the bend of the ureter, and other signs allows you to identify the cause of renal colic (nephrolithiasis, ureteral stone, hydronephrosis, nephroptosis, etc.).
- Urinary tract endoscopy. Chromocystoscopy performed during an attack reveals a delay or absence of indigocarmine release from a blocked ureter, sometimes swelling, hemorrhage or a stone pinched at the mouth of the ureter.
- Echography. To study the state of the urinary tract, ultrasound of the kidneys and bladder is prescribed; in order to exclude the “acute abdomen” – ultrasound of the abdominal cavity and pelvis.
- Tomography. To determine the cause of the developed renal colic, tomographic studies (CT of the kidneys, MRI) allow.
Pathology should be differentiated from other conditions accompanied by abdominal and lumbar pains – acute appendicitis, acute pancreatitis, cholecystitis, thrombosis of mesenteric vessels, aortic aneurysm, ectopic pregnancy, leg twisting of ovarian cyst, perforated stomach ulcer, epididymoorchitis, testicular twisting, herniated disc, intercostal neuralgia, etc.
Treatment
Relief of the condition begins with local thermal procedures (applying a warm warmer to the lower back or abdomen, a sitting bath with a water temperature of 37-39 ° C). In order to relieve pain, urinary tract spasm and restore the passage of urine, painkillers and antispasmodic drugs (sodium metamizole, trimeperidine, atropine, drotaverine or platyphillin intramuscularly) are administered.
It is advisable to try to remove a prolonged attack with the help of a novocaine blockade of the spermatic cord or a round uterine ligament of the uterus on the side of the lesion, intra-phase blockade, paravertebral irrigation of the lumbar region with chloroethyl. In the acute phase, acupuncture and electropuncture are widely used. With small concretions in the ureter, physiotherapy is performed – diadynamotherapy, ultrasound therapy, vibration therapy, etc.
With colic occurring against the background of acute pyelonephritis with a high rise in temperature, thermal procedures are contraindicated. In case of failure of the conservative measures taken, the patient is hospitalized in a urological hospital, where catheterization or ureteral stenting, puncture nephrostomy or surgical treatment is performed.
Prognosis and prevention
Timely relief and elimination of the causes leading to the development of renal colic, eliminates the possibility of relapse. With prolonged obstruction of the urinary tract, irreversible damage to the kidney may occur. The addition of infection can lead to the development of secondary pyelonephritis, urosepsis, bacteremic shock. Prevention consists in the prevention of possible risk factors, first of all – urolithiasis. Patients are shown an examination by a nephrologist and planned treatment of the disease that caused the development of the syndrome.