Causes of renal colic, symptoms and treatment. What you need to know about renal colic Renal colic symptoms in women what to do

Renal colic is acute, unbearable, paroxysmal pain in the lumbar spine caused by impaired outflow of urine from the kidney. At the same time, the blood supply to the organ is reduced, nutrients and oxygen are not supplied. The attack occurs unexpectedly, at any time of the day or night.

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Pathogenesis

Difficulty in the process of urination leads to overflow of the pelvis and calyces with urine, increased pressure, and as a result, blood circulation in the kidney is impaired.

Renal colic is an attack with serious impairment of organ functionality and injuries to the surfaces of the ureter.

The consequences of the condition pose a danger to a woman’s life.

Ureteral stones are usually small in size – up to 5 mm in diameter. They leave the body freely. Stones with a diameter of 5–10 mm pass away unexpectedly, and large ones (from 1 cm) are removed only in a hospital, for example, surgically. If the stone does not pass within 2 months, it will not pass away on its own.

Symptoms in women

Unpleasant painful sensations occur suddenly, without any preliminary signs. Renal colic has one main symptom is pain. There is no relief when changing body position. It is characterized by severity, contractions, and often occurs at night, during sleep.

In some patients with a low sensitivity threshold, vomiting and nausea are added. Pregnant women experience increased uterine tone, which poses a danger to the fetus. Spasms are transmitted to nearby organs. The intestines create false urges to empty. Hematuria (blood in the urine) and dysuria (impaired urination) are present. Elevated temperature occurs against the background inflammation and infection.

This depends on the degree of inflammation of the urinary tract. If there are stones in the pelvis, the source of pain is located above in the lumbar region, sensations are distributed to the rectum and abdomen.

When obstruction is present in the ureter, the source of pain is located in the lower back on the side of inflammation, pain can be felt in the groin, urethra, and external genitalia. In most patients the stomach and genitals hurt more than the kidneys. Parts of stones, blood and salts are found in the urine.

Only a doctor should diagnose an attack of renal colic so as not to confuse it with other causes of pain. These include running, sports games, excessive physical activity, drinking plenty of fluids, and using diuretics.

During an attack, additional symptoms appear:

• constant urge to urinate;
• drying of the oral mucosa;
• cutting, drawing pain in the rectum;
• chills;
• disruption of the heart;
• loose stool.

If these symptoms occur, you should immediately consult a doctor.

Causes of colic

An attack of renal colic is caused by the following pathological phenomena:

• contraction of the ureteral muscles;
• increased pressure in the pelvis;
• kidney ischemia;
• swelling of the parenchyma;
• stretching of the fibrous capsule;
• venous stasis;
• glucocorticoid therapy;
• blockage by blood clots;
• detached part of the tumor.

Urinary retention occurs due to concomitant diseases:

• pyelonephritis;
• kidney tuberculosis;
• allergic diseases;
• infectious diseases;
• urolithiasis disease. Stones in the pelvis move, become pinched in the ureter (usually in the lower section);
• compression of the ureter under the influence of tumors of neighboring organs;
• kidney injuries;
• bladder tumor.

Kinking of the ureter cause the following reasons:

• dystopia (improper arrangement of organs);
• nephroptosis;
• ureteral stricture (narrowed lumen);
• inflammatory process;
• heart attack;
• embolism;
• renal vein thrombosis;
• congenital anomalies;
• renal tumors;
• prostate cancer;
• prostate gland;
• venous phlebostenosis.

Duration of renal colic

Attack always lasts for a long period, in most cases from 12 to 24 hours.

Often the pain is observed for several days in a row, sometimes there are moments of weakening, but the unpleasant sensations do not disappear completely.

They increase progressively, the character is constant with intensified attacks.

The pain goes through three phases. Sometimes renal colic lasts less (from 3 hours). Highlight:

• Acute period. The attack appears at night or in the morning. During the day, it most often proceeds slowly. The peak intensity occurs in the 1st–2nd and 5th–6th hours of the attack.
• Constant period. The phase begins after 1–4 hours and lasts up to 12 hours. It is then that patients are given help and a course of treatment is prescribed.
• Fading period. For several hours, patients feel relief from pain relief.

Female characteristics

A condition associated with blockage of the urinary tract sometimes indicates surgical pathologies of the female reproductive system, which is not related to kidney function. This could be one of the following factors:

• fallopian tube ruptures;
• ovarian apoplexy;
• ovarian cyst when damaged.

Gynecological diseases are accompanied by additional symptoms:

• hypotension (low blood pressure);
• increased heart rate;
• pale skin;
• dizziness;
• cold sweat.

Syndrome in pregnant women

Symptoms of renal colic: pain with contractions, hematuria, passage of stones.

It is important for a pregnant woman to monitor her health in order to detect and diagnose the disease in time, stop pain, and prevent consequences.

The hardest thing complication – premature birth.

Painful spasms are relieved with antispasmodics. Manipulations are carried out under the supervision of a doctor.

Important! When providing first aid for renal colic, thermal procedures are strictly prohibited.

Complications

If the difficulty in the outflow of urine continues throughout the day, while the outflow of urine is blocked completely, this leads to to irreversible kidney damage. So, a stone that is located in the ureter manifests symptoms a month after its appearance.

Complications of renal colic:

• deterioration of kidney function;
• (purulent inflammation);
• difficulty in patency of the ureter;
• development of pyelonephritis.

Timely recognition of renal colic and qualified medical care will ensure the preservation of the kidney.

First aid

At home, first aid measures must be taken. The woman herself, under the influence of the syndrome, does not always know how to help herself. What to do in this state?

First aid consists of several stages:

1. Warming compress. The heating pad is applied to the area where painful spasms are felt (abdomen or back).
2. Sitz bath. Effective relief occurs when taking a hot bath, the temperature of which is 40 degrees.
3. Taking medications. Relief from spasm is achieved by taking No-shpa. Painkillers will temporarily reduce the pain threshold (Ketanov, Ibuprofen). An attack cannot be treated with painkillers; they do not affect the course of the disease, so simply stopping the symptoms is not worth it.

Repeated attacks of renal colic require mandatory hospitalization.

Doctor's help

1. Creating complete peace for the patient.
2. Measures to relieve spasms, stabilize the outflow of urine (thermal physiotherapy).
3. Administration of painkillers.
4. The use of medications that reduce spasms and antiemetics.
5. Taking drugs of the narcotic group (morphine, promedol, tramadol).
6. Carrying out a blockade according to Lorin-Epstein implies administration of novocaine solution in the area of ​​the peripheral part of the round ligament of the uterus. The procedure is performed for pelvic stones.
7. The use of intrapelvic blockade according to Shkolnikov is indicated for stones in the upper ureter.
8. Physiotherapy (vibration procedure, ultrasound therapy, exposure to Bernard's diadynamic currents) is carried out to facilitate the removal of small stones.

If these methods do not lead to positive results, treatment at home is prohibited, and urgent hospitalization of the patient is necessary.

Treatment of kidney diseases in a hospital includes the following procedures:

• ureteral catheterization;
• puncture nephrostomy;
• surgical intervention.

Diet for renal colic

Women should limit their intake of fats and carbohydrates. Eliminate heavy foods from your diet(fried, salty, spices, chocolate, coffee).

• light chicken broth;
• boiled sea fish;
• dairy products;
• fresh fruits, especially pears and apricots;
• cranberry juice;
• rosehip decoction.

Proper nutrition reduces the likelihood of recurrence of renal colic by 75%.

Preventive measures help avoid an attack. Key recommendations include:

• Drink enough water(at least 2-2.5 l). The liquid dilutes the urine.
• Eat a balanced diet
• Limit salt intake.
• Avoid overheating the kidneys.
• Drink urological drinks (herbs, berries).

Attention! Long-term blockades negatively affect the functionality of the kidneys, leading to hydronephrosis and complete loss of the kidney.

Video: symptoms and treatment of renal colic

Conclusion

Having identified the symptoms of renal colic, you should immediately provide first aid and contact a medical facility for further treatment. Timely diagnosis and compliance with preventive measures will save the woman not only her kidney, but also her life.

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The occurrence of unbearable pain in the lower back, which does not leave the patient alone, forces him to rush about in bed and does not allow him to sit or lie quietly, is almost always a symptom of acute renal colic. This is not a disease, but a symptom of some pathology.

But in any emergency condition, it is initially necessary to eliminate unbearable pain in order to alleviate the patient’s condition. Treatment of the pathology itself is a secondary task.

In order to detect an attack of renal colic, provide adequate assistance and eliminate the cause of the pathology, you need to have reliable information regarding this pathological condition. This is exactly what will be presented in the article.

Fundamentals of the structure of the human urinary system

It is quite difficult to understand the causes of renal colic and the basic principles of its treatment without having data on the process of urination. It all starts with the production of urine by the kidney tissue, then it passes into the pelvis - hollow formations that are located at the outlet of the kidneys. Quite often, stones are located in the pelvis, since their lumen is quite narrow, only a few mm.

The next organ of the urinary system, the ureter, originates from the pelvis. To put it quite simply, it is a hollow tube that communicates with the bladder and kidneys. The ureter is the second “favorite” location for stones. The diameter of the lumen of this organ ranges from 5 to 15 mm, as a result of which blockages of its lumen can form in narrow areas.

After accumulation in the bladder, the fluid moves further along the urethra and is discharged out. This area most often quite rarely becomes the cause of an emergency.

Causes

The development of colic can be triggered by various pathologies, but they are united by one common feature - obstruction (blockage) of the urine drainage tract. Each of the pathologies leads to disruption of the outflow of fluid and leads to the development of characteristic symptoms. Blockage of the lumen of the urinary tract can occur at various levels (in the ureter, pelvis and even in the bladder itself), but the manifestations of the pathology are almost identical.

What pathologies can provoke obstruction? Today the most common diseases are:

It is also necessary to highlight one important point - when symptoms of renal colic develop after emergency care, you must first determine the absence/presence of a stone in the lumen of the pelvis or ureter. Only after this can you move on to excluding other diseases.

Symptoms

To diagnose this condition in a patient, only one symptom is enough - characteristic pain. In addition to the pain, two more symptoms may occur: changes in urination and vomiting. These are not necessarily manifestations of colic, but they are quite often observed in patients with such an emergency condition.

Pain

The main complaint for all patients with this pathological condition is the presence of pain in the clinical picture. What kind of pain occurs with renal colic? This is a very intense, cutting pain that patients describe as “unbearable.” Unpleasant sensations haunt you, preventing you from sitting or lying down normally; patients become overexcited and cannot find a place to sit.

The pain is located in the lumbar region and most often radiates to:

into the perineum;

on the front surface of the thigh;

renal colic in women radiates to the vagina and labia;

colic in men spreads to the head of the penis, scrotum, testicle.

This symptom may intensify when palpating the abdomen (in certain places, usually 3-5 cm on the sides of the navel) or tapping the lower back. The first sign is not obligatory and develops only when the ureter is damaged.

Dysuria (impaired urination)

Blockage of the urinary tract in most cases leads to the development of this symptom. The patient feels a false urge to urinate, but the amount of urine released is quite small. The process of urination itself is quite unpleasant, since cutting pain occurs in the lower back and perineum. Due to injury to the walls of organs and bleeding (small), urine quite often becomes reddish or pinkish.

Can urine have a normal color? Yes, but only when it comes from a healthy kidney. Unfortunately, it is impossible to determine the path of urine outflow at home, so this symptom has additional significance.

Vomit

The development of such a symptom is caused by two mechanisms. The first is severe pain that the brain cannot cope with on its own. As a result of unsuccessful attempts, autonomic disorders develop: general weakness, increased sweating, nausea, vomiting. The second mechanism is the disruption of the solar plexus nerves (at the location of pain), as a result, the functioning of most of the digestive tract is disrupted.

Most often, vomiting is repeated and has nothing to do with ingestion of water or food and develops spontaneously. Taking various sorbents (Smecta, Neosmectin, activated carbon) does not help cope with her attacks.

Can all symptoms suddenly subside? Yes, it is quite. The reason for spontaneous improvement is a change in the position of the stone and normalization of urine outflow. In the case of a small stone size (3-5 mm), it may well come out on its own, which will provoke the disappearance of all the above symptoms. Unfortunately, such self-healing is a rather rare phenomenon, and you should not rely on it; it is better to seek specialized help as quickly as possible.

Features of the course of renal colic in children

It is sometimes quite difficult to recognize the presence of this condition in a child. Due to the characteristics and mentality of the nervous system, the symptoms of renal colic most often differ from the generally known symptoms. In children, renal colic in most cases manifests itself as widespread pain throughout the abdomen in combination with impaired urination and the presence of dyspeptic symptoms: constipation/loose stools, vomiting, flatulence, nausea. All these signs lead to difficulties in diagnosis and misdiagnosis.

How to act correctly in such cases? You need to pay attention to the presence of dysuria. If this symptom is combined with abdominal pain, then renal pathologies must be excluded.

Treatment

Help with the development of renal colic should consist of two stages. The first is to relieve pain. Restoring the normal flow of urine and eliminating discomfort is very important, not only to improve the patient’s well-being, but also to preserve the functioning of the kidney. After achieving this goal, you need to move on to the next stage. This stage consists of treating the pathology that led to the development of the emergency condition. This problem is dealt with by highly specialized specialists after the end of the acute period.

First aid

How to behave if renal colic occurs at home? First of all, you should call an ambulance. Considering the fact that the team will not be able to arrive instantly, you need to start relieving the condition yourself. To do this, perform the following activities:

Warm the lumbar area. A warm bath (water temperature in which is 38-40 degrees) will give the optimal effect, since it affects not a specific area, but the whole body. An alternative to a bath is a heating pad. But it is worth remembering that if kidney tuberculosis is suspected, heat is contraindicated.

Give the patient a pain reliever. For these purposes, products with a combined effect that combine antispasmodics and NSAIDs are best suited. Together, these drugs have a relaxing and anti-inflammatory effect on the organs of the excretory system. Examples of such drugs: “Baralgin”, “Spazmalgon”, “Revalgin”. As an alternative, you can use conventional non-steroidal anti-inflammatory drugs - Citramon, Paracetamol, Ketorolac, Diclofenac.

These actions are performed simultaneously, since it takes about half an hour for the tablets to take effect. The combined effect of first aid measures can slightly improve the patient’s well-being before the arrival of a paramedic or doctor.

How to relieve pain if first aid has no effect? In such cases, the patient needs to perform a blockade - local anesthesia of the nerve and then, as an emergency, promptly restore the outflow of urine. But such assistance can only be performed in a hospital setting.

Who needs mandatory hospitalization?

The emergency doctor almost always recommends continuing treatment for renal colic in the hospital. Unfortunately, not all patients agree to this offer for personal reasons. This may cause a lack of adequate therapy and a relapse of the attack in the future.

But there is a group of patients for whom hospitalization is a vital measure. Even after the acute period of pathology has subsided, you should seek help from a hospital if the following conditions exist:

signs of a severe complication appear: pressure drop below 100/70 mmHg. Art., impaired consciousness, increased body temperature above 38 degrees;

when pain occurs on both sides;

the patient has only one kidney.

If patients with the problems listed above do not restore urinary function within several hours, the result may be irreversible organ destruction and even death.

Restoring urine flow

The standard algorithm for the presence of renal colic, which is resistant to conventional methods of therapy, is surgical intervention. In modern surgical practice, the intervention is performed through the urethral opening or through making one hole in the skin. The following options for restoring the outflow of urine are also possible:

Percutaneous nephrostomy is most often an emergency treatment method when the surgeon is unable to use endoscopic techniques or they are ineffective. The principle of the method is to introduce drainage into the cavity of the pelvis using a puncture in the skin.

Ureteral stenting - another type of endoscopic intervention is the installation of a special drainage into the pelvis. This method provides a bypass for urine and relieves colic symptoms.

Endoscopic stone removal is the most effective operation, which is performed through the external opening of the urethra. It makes it possible to restore the process of urine outflow in the shortest possible time and with minor trauma.

Only after urine output has been normalized does it make sense to begin treatment for the underlying pathology. If the patient has been hospitalized, all necessary diagnostics are performed in the hospital. In case of outpatient treatment, the patient is referred to a local therapist.

Complications

If assistance is provided in a timely manner, the prognosis for an emergency condition is favorable. Complications can only arise if treatment is delayed or incorrect. The severity of such conditions can vary, it all depends on the condition of the patient and the duration of stagnation of urine. Among the most common complications are:

• persistent narrowing of the ureter;

  pyelonephritis – inflammation of kidney tissue with suppuration;

  kidney atrophy or nephrosclerosis.

In clinical practice, there are even cases of fatal pathology after attempts at independent long-term treatment with folk remedies. All of the above complications (except for pyelonephritis) are quite difficult to treat, but it is much easier to prevent - to do this, just contact a specialist for help.

FAQ

How are renal colic and vomiting related?

The reason lies in the structure of the nervous system. The gastrointestinal tract and kidneys receive innervation from one nerve plexus - the celiac trunk or nerve plexus. If there is a disturbance in the outflow of urine, which is always present when a stone passes through the ureter, the solar plexus is irritated. Irritation leads to a reflex disturbance of the innervation of the gastrointestinal tract. This leads to nausea and vomiting, and also causes bloating during an attack and constipation.

Why does your bladder always feel like it's full, but when you urinate, very little urine comes out?
This is due to the structural features of the human nervous system. As the stone passes through the lower third of the ureter, receptors are irritated, which provoke a false urge to urinate. This sign can be regarded as positive, since most of the path of the stone has already been passed. However, this should also cause some concern, since the junction of the ureter and bladder is the narrowest in the entire system, so the stone is most likely to get stuck there.

What can trigger the onset of renal colic?

Most often it begins without previous actions, spontaneously, while performing normal activities or at rest. But this does not always happen; some patients had a long train or car ride before the attack occurred. Also among the provoking factors, one should highlight the use of herbal preparations intended for the treatment of urolithiasis, since they provoke the release of stones. Sometimes the stone begins to move through the excretory system after a strong blow to the back. There are also cases in practice where a patient limited himself to fluids for a long time, and then drank a lot of water, which became the cause of an attack.

What is the mechanism of development of pain syndrome?

If the ureter is blocked by a stone, the process of urine outflow is disrupted. At the same time, new portions continue to be produced and enter the system, but due to blockage of the duct they accumulate in the renal collecting system. Over time, the expansion increases and leads to compression of the vessels feeding the kidney, causing circulatory problems.

It is worth noting that the size of the macrolite cannot affect the severity of pain; even when a stone with a diameter of 1-1.5 mm comes out, a severe attack of renal colic can occur.

Can this condition be confused with symptoms of other diseases?

There are many known pathologies that mimic renal pain. Among them:

acute pleurisy;

radiculitis;

kidney infarction;

ectopic pregnancy;

torsion of ovarian cyst;

acute appendicitis in adults.

Accordingly, the obvious conclusion arises - it is strictly prohibited to independently treat this emergency condition. First, you need to accurately establish the cause of the pain and carry out a differential diagnosis, and then proceed to treatment, which is only possible in a hospital setting.

Can a stone reach the bladder and not come out?

This happens quite rarely, for example, in the presence of prostate adenoma or urethral strictures, when the urethra narrows significantly. Most often, after a stone enters the bladder, it comes out through the urethra, since its diameter is much larger than the diameter of the ureter.

What diagnostic techniques are used for renal colic?

Diagnosis begins with collecting an anamnesis of the pathology (when it began, how it manifested itself, how the nature of the symptoms changed over time). After this, the patient is examined and laboratory tests are carried out, including a biochemical blood test and a general analysis of urine and blood. Among the instrumental techniques used are urography (excretory or intravenous) and ultrasound.

What does a physical examination of the patient show?

During the examination, pain is detected in the projection of the ureter and in the kidney area. Differential diagnosis with other acute surgical pathologies is also performed.

Why is ultrasound examination needed?

This method is safe, relatively inexpensive and accessible. Using ultrasound, you can see the expansion of the renal pelvis, macrolites and stones in the ureter, and determine the level at which the stone has stopped. But this method is not always highly informative; with increased gas formation and obesity, visualization may be impaired. Also, diagnosis may be difficult in the presence of certain anomalies of the urinary system. Therefore, it is important not to settle on one diagnostic method.

What does excretory urography show and what is it for?

This diagnostic method is the most informative. It is performed in several stages. First, an X-ray is taken, after which a contrast agent is injected. It quickly penetrates into the urine. After this, another photograph is taken, which clearly shows the filling of the ureter and renal pelvis, as well as the level at which the stone is located and its size. A contraindication to this procedure is an allergy to iodine or thyrotoxicosis, since iodine is the coloring substance.

What therapies are used?

If the patient has confirmed renal colic, then treatment is selected based on the origin of this symptom. If the cause is urolithiasis, then there may be three treatment options. The first is lithokinetic therapy. When the results of the examination confirm that this method will not be effective, they move on to extracorporeal lithotripsy or open surgery. The latter is used quite rarely today.

What is the essence of lithokinetic therapy?

If the stone is large and the probability of its passage on its own is quite high, a number of drugs are prescribed that can speed up this process. Among them are non-steroidal anti-inflammatory drugs (relieve swelling of the ureter and relieve pain), alpha blockers (relax the smooth muscles that line the ureter), antispasmodics (expand the lumen of the ureter).

How long does it take for a stone to pass when using lithokinetic therapy?

This usually takes several days, but if after 2-3 days the stone does not come out on its own, a repeat examination is carried out. Quite often, after this, treatment tactics are changed, but if positive dynamics are observed, then conservative treatment is continued. If a stone stays at one point for a long time, it is dangerous for the development of fibrosis of the ureter in this place.

What should be understood by extracorporeal lithotripsy?

This method is the “gold standard” in the treatment of urolithiasis. It has been around for three decades and has proven itself to be excellent. Its essence lies in the fact that with the help of a directed beam of mechanical waves they influence the calculus and thus lead to its destruction. The procedure is performed under ultrasound or x-ray control. The effectiveness of this procedure is over 95%.

What should you do if the pain has disappeared, but the stone has not come out?

Stones must be removed even when they are not bothering you. If the stone remains in the ureter, but does not block the outflow of urine, trauma to the walls of the ureter continues to occur. The outflow is impaired, and overflow of the renal pelvis leads to the development of hydronephrosis with damage to the renal parenchyma. Therefore, to avoid the development of these complications, the stone should be removed, regardless of the presence of symptoms.

Separately, it is necessary to mention that after an attack of renal colic, when the occlusion of the ureter is eliminated, the pain syndrome becomes less pronounced ( the pain becomes aching) and a relatively large amount of urine is excreted ( accumulation of which occurred in the pelvis of the affected kidney). Impurities or clots of blood, pus, and sand may be seen in the urine. Occasionally, individual small stones may be passed along with the urine, a process sometimes called “birth of a stone.” In this case, the passage of a stone through the urethra can be accompanied by significant pain.

Diagnosis of renal colic

It is necessary to understand that the process of diagnosing renal colic has two main goals - establishing the cause of the pathology and differential diagnosis. To establish the cause, it is necessary to undergo a series of tests and examinations, as this will allow for more rational treatment and prevent ( or postpone) repeated exacerbations. Differential diagnosis is necessary in order not to confuse this pathology with others that have a similar clinical picture ( acute appendicitis, hepatic or intestinal colic, perforated ulcer, thrombosis of mesenteric vessels, adnexitis, pancreatitis), and prevent incorrect and untimely treatment.


Due to the pronounced pain syndrome that forms the basis of the clinical picture of renal colic, people with this disease are forced to seek medical help. During an acute attack of renal colic, adequate assistance can be provided by a doctor of almost any specialty. However, as mentioned above, due to the need to differentiate this disease from other dangerous pathologies, you should first contact the surgical, urological or therapeutic department.

Be that as it may, the most competent specialist in the treatment, diagnosis and prevention of renal colic and its causes is a urologist. It is this specialist who should be contacted first if you suspect renal colic.

If renal colic occurs, it makes sense to call an ambulance, as this will allow earlier treatment aimed at eliminating pain and spasm, and will also speed up the process of transportation to the hospital. In addition, the emergency doctor makes a preliminary diagnosis and sends the patient to the department where he will receive the most qualified care.

Diagnosis of renal colic and its causes is based on the following examinations:

• survey;
• clinical examination;
• ultrasonography;
• X-ray research methods;
• laboratory urine test.

Survey

During the survey, the following facts are revealed:

• Characteristics of pain. Pain is a subjective indicator that cannot be quantified and the assessment of which is based only on the patient's verbal description. To diagnose renal colic, the time of onset of pain and its nature are important ( sharp, dull, aching, constant, paroxysmal), the place of its distribution, changes in its intensity when changing body position and when taking painkillers.
• Nausea, vomiting. Nausea is also a subjective sensation, which the doctor can only learn about from the patient’s words. The doctor must be informed when the nausea began, whether it is associated with food intake, and whether it gets worse in some situations. It is also necessary to report episodes of vomiting, if any, their connection with food intake, and changes in general condition after vomiting.
• Chills, increased body temperature. It is necessary to inform the doctor about the development of chills and elevated body temperature ( if, of course, it was measured).
• Changes in urination. During the interview, the doctor finds out whether there are any changes in the act of urination, whether there is an increased urge to urinate, or whether blood or pus is discharged along with the urine.
• Presence of attacks of renal colic in the past. The doctor must find out whether this is the first time this attack has occurred or whether there have been previous episodes of renal colic.
• Presence of diagnosed urolithiasis. It is necessary to inform your doctor about the presence of urolithiasis ( if there is one now, or was in the past).
• Diseases of the kidneys and urinary tract. The presence of any pathologies of the kidneys or urinary tract increases the likelihood of renal colic.
• Surgeries or injuries to the urinary system or lumbar region. It is necessary to inform your doctor about previous surgeries and injuries to the lumbar region. In some cases, also about other surgical interventions, as this allows us to suggest possible risk factors, as well as speed up differential diagnosis ( removal of the appendix in the past excludes acute appendicitis in the present).
• Allergic reactions. It is imperative to inform your doctor if you have any allergic reactions.

• diet;
• infectious diseases ( both systemic and urinary tract organs);
• intestinal diseases;
• bone diseases;
• place of residence ( to determine climatic conditions);
• place of work ( to clarify working conditions and the presence of harmful factors);
• use of any medicinal or herbal preparations.

Clinical examination

During a clinical examination, it is necessary to undress so that the doctor has the opportunity to assess the general and local condition of the patient. To assess the condition of the kidneys, percussion can be performed - lightly tapping the back with a hand in the area of ​​the twelfth rib. The occurrence of pain during this procedure ( Pasternatsky's symptom) indicates damage to the kidney on the corresponding side.

To assess the position of the kidneys, they are palpated through the anterior abdominal wall ( which can be tense during an attack). The kidneys are rarely palpated during this procedure ( sometimes only their lower pole), however, if it was possible to palpate them completely, then this indicates either their descent or a significant increase in their size.

To exclude pathologies that have similar symptoms, deep palpation of the abdomen, gynecological examination, and digital examination of the rectum may be required.

Ultrasonography

Ultrasound examination without preliminary preparation may be less sensitive, but in emergency cases, when urgent diagnosis is necessary, the information obtained is quite sufficient.

Ultrasound is indicated in all cases of renal colic, as it allows you to directly or indirectly visualize changes in the kidneys, and also allows you to see stones that are not visible on x-ray.

In renal colic, ultrasound allows you to visualize the following changes:

• expansion of the pyelocaliceal system;
• an increase in kidney size by more than 20 mm compared to another kidney;
• dense formations in the pelvis, ureters ( stones);
• changes in the structure of the kidney itself ( previous pathologies);
• swelling of the kidney tissue;
• purulent foci in the kidney;
• changes in hemodynamics in the renal vessels.

X-ray research methods

Radiation diagnostics of renal colic includes:

• Plain X-ray of the abdomen. An overview image of the abdomen allows you to visualize the area of ​​the kidneys, ureters, bladder, as well as the condition of the intestines. However, using this research method, only X-ray positive stones can be detected ( oxalate and calcium).
• Excretory urography. The method of excretory urography is based on the introduction into the body of a contrast X-ray positive substance, which is excreted by the kidneys. This allows you to monitor blood circulation in the kidneys, evaluate the filtration function and concentration of urine, and also monitor the excretion of urine through the collecting system and ureters. The presence of an obstacle leads to a delay of this substance at the level of occlusion, which can be seen in the image. This method allows you to diagnose blockage at any level of the ureter, regardless of the composition of the stone.
• CT scan. CT scans produce images that help evaluate the density of stones and the condition of the urinary tract. This is necessary for a more thorough diagnosis before surgery.

Computed tomography is indicated for suspected urolithiasis caused by urate ( uric acid) and coral-shaped ( more often – post-infectious nature) stones. In addition, tomography allows you to diagnose stones that could not be detected by other methods. However, due to the higher price, CT scans are used only when absolutely necessary.

Excretory urography is carried out only after complete relief of renal colic, since at the height of the attack not only the outflow of urine stops, but also the blood supply to the kidney is disrupted, which, accordingly, leads to the fact that the contrast agent is not excreted by the affected organ. This study is indicated in all cases of pain arising in the urinary tract, urolithiasis, detection of blood in the urine, and injuries. Due to the use of a contrast agent, this method has a number of contraindications:

Excretory urography is contraindicated in the following patients:

• with an allergic reaction to iodine and contrast agent;
• patients with myelomatosis;
• with a blood creatinine level above 200 mmol/l.

Laboratory urine test

During laboratory testing, morning urine is analyzed ( which accumulated in the bladder during the night, and the analysis of which allows us to objectively judge the composition of impurities) and daily urine ( which is collected during the day, and the analysis of which allows you to assess the functional capacity of the kidneys).

Laboratory testing of urine evaluates the following indicators:

• amount of urine;
• presence of salt impurities;
• urine reaction ( acidic or alkaline);
• the presence of whole red blood cells or their fragments;
• presence and quantity of bacteria;
• level of cysteine, calcium salts, oxalates, citrates, urates ( stone-forming substances);
• creatinine concentration ( kidney function indicator).

It is extremely important to analyze the chemical composition of the stone ( stone), since further therapeutic tactics depend on its composition.

Treatment of renal colic

First aid for renal colic

• Hot bath. A hot bath, taken before the ambulance arrives, can reduce spasm of the smooth muscles of the ureter, which helps reduce pain and the degree of blockage of the urinary tract.
• Local heat. If the bath is contraindicated or cannot be used, you can apply a hot heating pad or a bottle of water to the lumbar region or abdomen on the affected side.
• Smooth muscle relaxants(antispasmodics). Taking medications that help relax smooth muscles can significantly reduce pain and, in some cases, even cause the stone to pass on its own. For this purpose, the drug No-shpa is used ( drotaverine) in a total dose of 160 mg ( 4 tablets of 40 mg or 2 tablets of 80 mg).
• Painkillers. Painkillers can only be taken for left-sided renal colic, since pain on the right side can be caused not only by this disease, but also by acute appendicitis, cholecystitis, ulcers and other pathologies in which self-administration of painkillers is contraindicated, as it can blur the clinical picture and make diagnosis difficult. To relieve pain at home, you can use ibuprofen, paracetamol, baralgin, ketanov.

Drug treatment

The following categories of patients are subject to mandatory hospitalization:

• who do not have a positive effect from taking painkillers;
• who have a blockage of the urinary tract due to a single functioning or transplanted kidney;
• blockage of the urinary tract is combined with signs of infection of the urinary system, a temperature of more than 38 degrees.

Drug treatment involves the introduction of drugs into the body that can alleviate symptoms and eliminate the pathogenic factor. In this case, preference is given to intramuscular or intravenous injections, since they provide a faster onset of action of the drug and do not depend on the functioning of the gastrointestinal tract ( vomiting may significantly reduce absorption of the drug from the stomach). After stopping an acute attack, it is possible to switch to tablets or rectal suppositories.

To treat renal colic, drugs with the following effects are used:

• painkillers - to eliminate pain;
• antispasmodics - to relieve spasm of the smooth muscles of the ureter;
• antiemetic drugs - to block reflex vomiting;
• drugs that reduce urine production - to reduce intrapelvic pressure.

Painkillers

Antispasmodics

Antiemetic drugs

Drugs that reduce urine production

In addition to the listed drugs, drugs from the group of calcium channel blockers can be used ( nifedipine), nitrates ( isosorbide dinitrate), alpha-blockers and methylxanthines, which can reduce smooth muscle spasm and eliminate pain, but whose effectiveness in renal colic has not yet been sufficiently studied.

In some cases, drug treatment also involves the use of drugs that help dissolve stones in the urinary tract. It should be borne in mind that only uric acid stones can be dissolved by medication. For this purpose, drugs that alkalize urine are used.

Drugs used to dissolve uric acid stones

In parallel with this, treatment of the pathology that caused stone formation is provided. For this, various vitamins and minerals, nutritional supplements, drugs that reduce the concentration of uric acid, and diuretics can be used.

Surgery

Surgical treatment of renal colic is indicated in the following situations:

• complicated urolithiasis;
• hydronephrosis of the kidney ( hydrocele of the kidneys);
• kidney shrinkage;
• ineffectiveness of drug treatment;
• stones more than 1 cm in diameter that cannot pass on their own.

Stones can be removed in the following ways:

1. extracorporeal lithotripsy;
2. contact lithotripsy;
3. percutaneous nephrolithotomy;
4. endoscopic stone removal;
5. ureteral stenting;
6. open kidney surgery.

This method of destroying stones is used when the size of the stones is less than 2 cm and their location in the upper or middle part of the pelvis.

External lithotripsy is contraindicated in the following situations:

• bleeding disorders;
• densely spaced stones;
• blockage of the ureter.

Percutaneous nephrolithotomy
Percutaneous nephrolithotomy is a method of surgical removal of kidney stones in which a small puncture is made ( about 1 cm) skin and a special instrument is inserted through it, with the help of which the stone is removed. This procedure involves constant monitoring of the position of the instrument and the stone using fluoroscopic examination.

Endoscopic stone removal
Endoscopic stone removal involves inserting a special flexible or rigid instrument equipped with an optical system through the urethra into the ureter. At the same time, thanks to the ability to visualize and capture the stone, this method allows you to immediately remove it.

Ureteral stenting
Ureteral stenting involves the endoscopic introduction of a special cylindrical frame, which is installed at the site of narrowing of the ureter or its incision, to prevent stones from getting stuck in the future.

Open kidney surgery
Open kidney surgery is the most traumatic method of removing stones, which is currently practically not used. This surgical intervention can be used in case of significant damage to the kidney, with purulent-necrotic changes, as well as in case of massive stones that are not amenable to lithotripsy.

Preparation for surgical removal of stones involves the following activities:

• Taking tests. Before surgery, it is necessary to take a general urine test and a general blood test, do fluorography, and conduct an ultrasound and x-ray examination of the kidneys.
• Consultation with a therapist. To exclude possible contraindications and systemic pathologies, it is necessary to consult a therapist.
• Diet. A proper diet allows you to avoid excess gas formation and accumulation of feces in the intestines, which greatly simplifies the intervention. To do this, a few days before the operation you need to give up fermented milk products, fresh vegetables, and legumes. On the day of the procedure, eating is prohibited.

Treatment with folk remedies

The following medications can be used to treat renal colic:

• Hot bath. As mentioned above, hot water helps relax the smooth muscles of the ureter. You can add 10 g to water ( 2 tablespoons) cudweed grass, sage leaves, birch leaves, chamomile and linden flowers.
• Medicinal infusion. Six tablespoons of a mixture of birch leaves, steelberry root, juniper fruits and mint leaves must be poured into 1 liter of boiling water and left for half an hour. The resulting decoction should be consumed warm within an hour.
• Decoction of birch leaves. Eight tablespoons of birch leaves, twigs or buds should be poured with 5 glasses of water and boiled for 20 minutes in a water bath. Consume hot within 1 – 2 hours.

The following types of stones can be treated with traditional methods:

1. urate ( uric acid) stones;
2. oxalate and phosphate stones.

Urate stones can be treated with the following decoctions:

• Lingonberry decoction. Two tablespoons of a mixture of lingonberry leaves, knotweed, parsley root and calamus rhizome are poured with a glass of boiling water and boiled for 10 minutes in a water bath. Drink 70-100 ml three times a day 20-40 minutes before meals.
• Barberry decoction. Two tablespoons of the fruits of barberry, juniper, shepherd's purse grass, and steelberry root are poured with a glass of boiling water and boiled for a quarter of an hour, then left for 4 hours. Use warm, 50 ml 4 times a day before meals.
• A decoction of birch leaves. Two tablespoons of birch leaves, black elderberry flowers, flax seeds, parsley, rose hips are placed in 1.5 cups of boiling water and left for an hour. Take 70–100 ml 3 times a day before meals.

Treatment of oxalate and phosphate stones is carried out using the following methods:

• Decoction of barberry flowers. Two tablespoons of a mixture of barberry flowers, immortelle flowers, lingonberry leaves, black elderberry flowers, sweet clover herb, motherwort herb are poured with a glass of boiling water, boiled in a water bath for 10 minutes and left for 2 hours. Take 50 ml 3 times a day before meals.
• Decoction of budra herb. Two tablespoons of budra herb, blue cornflower flowers, wintergreen leaves, peppermint leaves are poured with one and a half glasses of boiling water, boiled for 5 minutes and left for an hour. Take 50 ml 4 times a day before meals.
• Decoction of immortelle flowers. Two tablespoons of a mixture of immortelle flowers, budra grass, black elderberry flowers, blue cornflower flowers, bearberry leaves, burnet rhizomes are poured with a glass of boiling water, boiled in a water bath for a quarter of an hour and left for 4 hours. Take 50 ml warm 4 times a day before meals.

Prevention of renal colic

What do we have to do?

• consume sufficient amounts of vitamins A, D;
• sunbathing ( stimulate vitamin D synthesis);
• consume enough calcium;
• drink at least 2 liters of water per day;
• treat pathologies and infections of the urinary system;
• correct congenital metabolic pathologies;
• take walks or other physical exercise.

What should you avoid?

It is necessary to follow a diet for the following types of stones;

• Oxalate stones. It is necessary to reduce the intake of oxalic acid, which is found in lettuce, spinach, sorrel, potatoes, cheese, chocolate, and tea.
• Cysteine ​​stones. Since cysteine ​​stones are formed as a result of a violation of cysteine ​​metabolism, it is recommended to limit the consumption of eggs, peanuts, chicken meat, corn, and beans.
• Phosphate stones. It is necessary to reduce the consumption of dairy products, cheese, and vegetables.
• Uric acid stones. When uric acid stones form, it is necessary to reduce the intake of uric acid, which is found in meat products, smoked foods, legumes, coffee and chocolate.

• hypothermia;
• drafts;
• systemic and urological infections;
• dehydration;
• lumbar region injuries;
• sedentary lifestyle.

Renal colic itself is not a disease, but is a symptom that indicates, with fairly pronounced manifestations, that something is wrong in the body. The main manifestation accompanying this condition is pain. Renal colic, for which first aid is aimed specifically at eliminating this pain, occupies an “honorable” second place in terms of the frequency of its own occurrence, following the manifestations of acute appendicitis.

Causes of renal colic

The following conditions are identified as causes of renal colic:

• urolithiasis disease;
• disturbances in mineral metabolism;
• pyelonephritis;
• nephroptosis;
• hydronephrosis;
• tumor formations in the kidney area;
• diseases associated with the functions of the prostate gland, etc.

In general, in about 38% of the total number of cases of this condition, the causes of renal colic cannot be determined. Meanwhile, the most common cause is determined by the relevance for the patient of urolithiasis, in which the lumen of the ureter is blocked by a stone.

Renal colic, the first aid for the appearance of which we will discuss below, requires contacting a doctor after its appearance, and it is important to do this in any case, even if the pain goes away on its own and quickly enough. The fact is that this condition may indicate the presence of one or another, often extremely dangerous, disease, the treatment of which should be started immediately. Such diseases include, for example, tumors (whether it is a benign tumor formation or a cancerous formation).

In the case of the formation of kidney stones and the appearance of renal colic against the background of kidney stones, this condition is accompanied first by pain, and then by the appearance of blood in the urine when urinating.

Renal colic, provoked by a blood clot of dense consistency, as a result of which the ureter is blocked, initially determines the presence of blood in the urine, and only after that the renal colic itself develops.

Symptoms of renal colic

Renal colic can appear completely suddenly, even against the background of normal well-being of a person. In addition, its peculiarity lies in the severity of the manifestations accompanying the condition as a whole. So, the patient experiences a sharp pain, concentrated in the lumbar region, this pain has a pulsating nature, and in this situation it will not be possible to reduce its intensity just by changing the position of the body. When taking any position of the body, the pain does not subside, the patient is in a restless state, almost reaching a state of painful shock.

Renal colic is often accompanied by symptoms indicating intoxication, which manifests itself in severe tremor (shaking) of the limbs, nausea and vomiting, general weakness and disturbances of consciousness. In addition, there is a urge to urinate, which is also very painful.

In almost all situations, renal colic is accompanied by intestinal paresis, which occurs at the reflex level as a reaction to severe pain in the area in question. This manifests itself in the form of difficulty in passing gas, constipation, and bloating.

Renal colic: first aid

As we have already noted, renal colic, when it occurs, requires mandatory consultation with a doctor; it is necessary to call it, regardless of how intense the pain sensations relevant to this condition are and how long the attack itself lasts. Signs of renal colic can often imply completely different diseases, which simply cannot be treated without emergency specialized care. This could be appendicitis or ectopic pregnancy, an attack of cholecystitis or pancreatitis, as well as any other pathology.

Often, renal colic is mistakenly diagnosed as intestinal obstruction, and this is quite reasonable - the clinical picture in both cases is almost identical.

Providing first aid for renal colic requires, first of all, the conviction that the problem here is really this condition, and not something else. If this is an acute disease, heat is completely contraindicated in it, which cannot be said about renal colic, in which, on the contrary, it is necessary. Accordingly, to determine a specific condition, the signs of renal colic are assessed, which is described somewhat above; in this case, you need to pay particular attention to the manifestations of pain, which in the condition of interest to us is cramping. Factors such as frequent urination are also taken into account.

In particular, first aid for renal colic consists of providing the victim with warmth. However, if he has a high temperature and impaired consciousness, this point is skipped as an implementation measure.

If the patient has a normal temperature and actually has renal colic, then the most effective first aid measure is a hot bath, which must be taken in a sitting position. It needs to be filled with water as hot as a person can tolerate its maximum heating.

Again, there is a contraindication for this as well. So, if the victim of renal colic is an elderly person or a person who has one or another serious disease associated with the functions of the cardiovascular system, as well as a person who has previously suffered a heart attack or stroke, then a hot bath in these cases is unacceptable. In such cases, first aid for renal colic is to limit heat before using a heating pad on the lumbar region. In addition to this, mustard plasters can also be used; they should also be placed in the kidney area.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is renal colic?

Renal colic – complex symptoms associated with obstruction (blockage) of the upper urinary tract, and impaired outflow of urine from kidneys into the bladder.

This is a serious pathology that requires emergency medical care and hospitalization, since if the course is unfavorable, severe complications may develop.

Separately, we should highlight such a rare pathology as a wandering (drooping) kidney. In such cases, attacks of renal colic are caused by kinking of the ureter, and have certain characteristics: as a rule, they occur after a bumpy ride, long walking, physical activity, etc. The pain intensifies in an upright position and subsides in a lying position.

What is the mechanism of pain during an attack of renal colic?
(pathogenesis of renal colic)

In addition, a significant role in the development of severe pain syndrome is played by impaired urine outflow, leading to an increase in intrapelvic pressure, venous stasis and impaired microcirculation of the kidney. As a result, an increase in the size of the affected organ occurs, accompanied by overstretching of the richly innervated capsule.

The above pathological processes cause extremely severe pain in renal colic.

Symptoms of an attack of renal colic

An attack of renal colic can begin at any time of the year and at any time of the day, at home or while traveling, at work or on vacation.

The main and constant symptom of renal colic is excruciating pain of a cramping nature. The pain does not depend on movements, so the patient rushes around the room in the vain hope of finding a position that could at least somehow alleviate his suffering.

The localization and irradiation of pain, as well as some additional symptoms of renal colic, depend on the level of urinary tract obstruction.

When the stone is located in the renal pelvis, the pain is localized in the upper part of the lumbar region (in the corresponding costovertebral angle). In this case, the pain often radiates to the abdomen and rectum, and may be accompanied by painful tenesmus (a painful urge to have a bowel movement).

If the obstruction occurs in the ureter, the pain is localized in the lower back or side on the side of the affected kidney, and radiates along the ureter and down into the inguinal ligament, urethra, and external genitalia.

The pain syndrome is often accompanied by nausea and vomiting that does not bring relief. This kind of symptoms is especially characteristic when the obstruction is located in the upper parts (renal pelvis, upper parts of the ureter).

A very characteristic symptom of renal colic is hematuria (blood in the urine), which can be obvious (visible to the naked eye) and microscopic (determined by laboratory tests of urine).

When the obstruction is located in the lower parts of the ureters, dysuric phenomena (frequent painful urge to urinate) may occur.

It should be noted that the severity of pain and other symptoms of renal colic does not depend on the size of the stone, while an increase in body temperature may indicate the addition of infectious complications. High fever with chills should be especially alarming.

Differential diagnosis

General rules

• acute abdominal accidents (acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric ulcer, acute intestinal obstruction);
• acute gynecological pathology in women;
• damage to the lower urinary tract (cystitis, in men – prostatitis and urethritis);
• dissecting aortic aneurysm;
• neurological pathology (herniated disc, attack of radiculitis, intercostal neuralgia).

Thus, with obstruction in the renal pelvis and upper portion of the ureters, renal colic often occurs with symptoms characteristic of acute surgical diseases of the abdominal cavity (pain in the abdominal area, nausea, vomiting, increased body temperature).

When the obstruction is located in the ureters, especially in their middle part and below, pain often irradiates into the genitals, so differential diagnosis with acute diseases of the pelvic organs is necessary.

If the stones are located in the lowest segment of the ureters, the clinical picture is complemented by signs of dysuria (frequent painful urination, pain in the urethra, imperative urge to urinate), so cystitis should be excluded, and in men also prostatitis and urethritis.

Therefore, during differential diagnosis, one should carefully collect anamnesis, pay attention to the patient’s behavior and conduct additional studies in a timely manner.

Differential diagnosis of right-sided renal colic

In addition, if the stone is located in the right ureter, pain in renal colic can be localized in the right iliac region - the same as in acute appendicitis.

However, in the case of acute appendicitis, the pain is relieved by lying on the affected side, and intensifies when walking, so that patients move with a characteristic bend forward and to the affected side.

It should also be taken into account that the pain syndrome in acute appendicitis is localized, and in the case of renal colic, the pain radiates down to the thigh, to the inguinal ligament and to the area of ​​the external genitalia.

Renal and hepatic (biliary) colic
Pain from hepatic (biliary) colic can radiate to the right lumbar region. In addition, the nature of the pain syndrome is in many ways reminiscent of renal colic (extremely severe pain accompanied by vomiting that does not bring relief). Just as in the case of renal colic, patients with hepatic colic rush around the ward, since the intensity of the pain syndrome does not depend on body position, and the general condition of the patients is relatively satisfactory.

However, an attack of hepatic colic is typically associated with the consumption of fatty or fried foods (as a rule, an attack occurs two to three hours after errors in the diet). In addition, pain with hepatic colic radiates upward - under the right shoulder blade, into the right collarbone, and with renal colic - downwards.

Renal colic and acute intestinal obstruction

In addition, in the first phase of development of acute intestinal obstruction, patients behave in the same way as with renal colic, since the pain is severe, does not depend on body position, and the general condition is still relatively satisfactory.

However, volvulus is characterized by debilitating repeated vomiting, while with renal colic, vomiting is usually single. To establish a diagnosis, listening to the abdomen will help (the initial phase of acute intestinal obstruction is characterized by intense bowel sounds), as well as a urine test, which determines hematuria in the case of renal colic.

Differential diagnosis of atypical renal colic and abdominal disasters (acute pancreatitis, perforation of a gastric ulcer, acute cholecystitis)

In addition, an acute attack of renal colic is often accompanied by symptoms of local peritonitis on the affected side, such as severe pain in the abdominal wall and the absence of bowel sounds when listening to the abdomen.

Therefore, it can be difficult to make a differential diagnosis with abdominal disasters, such as acute pancreatitis, perforation of a gastric ulcer, acute cholecystitis.

In such cases, pay attention to the patient’s behavior. With an “acute abdomen”, patients, as a rule, due to their serious condition, are in bed, while patients with renal colic rush around the room, since their severe pain syndrome is combined with a relatively satisfactory general condition.

You should also pay attention to the characteristic symptoms of the diseases that caused the clinical picture of an “acute abdomen.”

Thus, the clinical picture of perforation of a stomach ulcer begins with a characteristic dagger pain, which is first localized in the epigastrium, and only then takes on a diffuse character. A specific sign of this pathology is an unusually strong reactive tension of the abdominal muscles (“board belly”).

First of all, the doctor conducts a survey, during which he asks about the characteristics of the pain - when the pain began, how it has changed over time, where it is felt, where it goes, what is the nature of the pain (sharp, dull, aching, constantly present or occurs in episodic attacks), changes the intensity of pain when changing position, whether the pain decreased after taking painkillers. The doctor also asks whether there was nausea and vomiting, what caused them, and whether they brought relief. The doctor must be interested in changes in urination - whether there have been any and what their nature is (for example, blood in the urine, pain when urinating, etc.). After this, the doctor asks whether there have been similar attacks in the past, whether a diagnosis of urolithiasis has been made in the past, whether the person has urinary tract diseases and whether he has had injuries or operations in the lumbar region during his life.

Having completed the interview, the doctor proceeds to a clinical examination, which includes the following actions:

• Measuring body temperature.
• Percussion of the kidneys, which is a light tap with the edge of the palm on the twelfth rib from the back. If pain occurs during such tapping, then this is a sign of renal colic, and is called a positive Pasternatsky symptom.
• Palpation of the kidneys (palpation) through the anterior abdominal wall. If you can palpate the kidneys, they turn out to be enlarged or slightly drooping.

After a survey and clinical examination, the doctor sees a complete clinical picture, on the basis of which, in fact, a diagnosis of renal colic is made. And then, to confirm the doctor’s clinical diagnosis, laboratory and instrumental examinations are prescribed.

What examinations and tests can a doctor prescribe for renal colic?

In addition, for renal colic, an ultrasound of the kidneys and urinary tract is prescribed and performed, which allows you to see and measure stones in the renal pelvis and ureters, which becomes an undoubted confirmation of the clinical diagnosis. In addition, ultrasound can detect purulent foci in the kidneys, if any. Ultrasound is not a mandatory method of examination for renal colic, and therefore may or may not be prescribed depending on the level of technical equipment of the medical institution. That is, ultrasound is more of an auxiliary method for diagnosing renal colic.

In case of renal colic, along with a general urine test, a survey X-ray of the abdomen and excretory urography are prescribed. Survey X-ray of the abdomen (make an appointment) allows you to detect oxalate and calcium stones (X-ray positive) in the kidneys and ureters, as well as assess the condition of the intestines. Although plain radiography is not a highly informative method, since it allows identifying only two types of stones, in case of renal colic, this is primarily done from instrumental examinations, since in most cases kidney stones are X-ray positive. And if stones can be identified by plain radiography of the abdomen, other instrumental examinations may not be prescribed.

After a general urinalysis and plain radiography, excretory urography is prescribed, which is an X-ray of the kidneys and urinary tract after the injection of a contrast agent into them. Urography allows you to evaluate blood flow in the kidneys, urine formation, and also identify where the stone is located (in which part of the ureter) that provoked renal colic.

The computed tomography method is highly informative in the diagnosis of renal colic, and can replace excretory urography. Therefore, if technically possible, computed tomography is prescribed instead of urography. But, unfortunately, in many cases, tomography is rarely prescribed due to the high cost of the method, lack of necessary equipment and specialists in medical institutions.

Forecast

After the attack of renal colic has stopped, dull pain in the lumbar region persists for some time, but the patient’s general condition improves significantly.

The further prognosis depends on the cause of renal colic. In the case of urolithiasis, long-term, virtually life-long treatment is required.

Complications

The most common complications include:

• acute obstructive pyelonephritis;
• urosepsis and bacteremic shock;
• decreased function of the affected kidney;
• formation of ureteral stricture.

Which doctor should I contact for renal colic?

Secondly, you can call an ambulance, and the arriving medical team will take the person to the hospital on duty in the city, where patients with a similar diagnosis are accepted and where there are appropriate specialists.

Treatment of renal colic

First aid

A warm bath or heating pad on the lumbar region helps relieve spasm of the ureter and the passage of stones. You can use antispasmodics from your home medicine cabinet. Most often, Baralgin is recommended (a medicine containing antispasmodics and an analgesic). Instead, you can take No-shpa or papaverine (antispasmodics).

In the absence of these medications, you can use nitroglycerin (half a tablet under the tongue), which also relaxes smooth muscle muscles and can relieve spasm of the ureter.

Before the doctor arrives, the patient is advised to write down the medications taken and monitor the urine for the passage of stones (it is best to collect urine in a vessel).

It should be noted that the presence of urolithiasis does not exclude the possibility of developing another acute pathology (for example, appendicitis). Therefore, if the attack proceeds atypically, it is better not to do anything until the doctor arrives. Heat and antispasmodics can aggravate infectious and inflammatory processes in the case of acute appendicitis or another disease from the group of pathologies with an “acute abdomen” clinical picture.

Emergency medical care

Drugs of choice:
1. Metamizole sodium (Baralgin M). Non-steroidal anti-inflammatory drug, analgesic. Used for pain of moderate intensity. Adults and adolescents over 15 years of age are administered intravenously, slowly (at a rate of 1 ml/min). Before administration, the ampoule should be warmed in your hand. After administration, urine may turn pink (no clinical significance). It is not compatible with alcohol, so chronic alcoholism is a relative contraindication to the administration of the drug. It is also better not to prescribe Baralgin M to patients with chronic kidney diseases (pyelo- and glomerulonephritis), and renal failure is an absolute contraindication. In addition, the drug is contraindicated in case of hypersensitivity to pyrazolones (Analgin).
2. Ketorolac. Non-steroidal anti-inflammatory drug, analgesic. Used for severe pain. The drug is administered in a dose of 1 ml intravenously, slowly (1 ml/15 seconds). Age under 16 years is a contraindication to prescribing the drug. In addition, the drug is contraindicated in bronchial asthma, severe renal failure and peptic ulcer disease in the acute stage.
3. Drotaverine (No-shpa). Antispasmodic. Inject intravenously, slowly 2-4 ml of standard solution (2%). Contraindicated in case of hypersensitivity to the drug and severe renal failure. Use with caution if you have a tendency to hypotension, open-angle glaucoma, severe atherosclerosis of the coronary arteries, or prostatic hyperplasia.

Indications for hospitalization for renal colic syndrome
Patients with renal colic syndrome are subject to emergency hospitalization in the following cases:

• bilateral renal colic;
• renal colic with a single kidney;
• elderly age;
• lack of positive dynamics after administration of drugs (intractable renal colic);
• the presence of clinical signs of complications (high fever with chills, anuria (lack of urine output), severe general condition of the patient);
• lack of conditions for outpatient monitoring and treatment.

In cases where the diagnosis of renal colic is in doubt, patients are hospitalized in the emergency department of a multidisciplinary hospital.

Recommendations for relieving renal colic for patients left at home
Renal colic can be treated on an outpatient basis when there are conditions for examination and treatment, and the diagnosis is not in doubt. So, if there is a positive effect from the administration of analgesics in young and middle-aged patients, they can be given recommendations for relieving kidney disease at home.

For renal colic, bed or semi-bed rest and a strict diet are prescribed (table N10, for diagnosed urate urolithiasis - table N6).

For further relief of pain, thermal procedures are recommended. As a rule, a heating pad on the lumbar area or a hot bath have a good effect.

You should empty your bladder in a timely manner, using a special vessel for subsequent monitoring of the passage of stones.

Patients should know that they should call an ambulance in the following cases:

• repeated attack of renal colic;
• the appearance of fever;
• nausea, vomiting;
• decreased amount of urine output;
• deterioration of general condition.

Diet

Treatment table N10 implies a slight reduction in the energy value of the diet by reducing the consumption of fats and carbohydrates. The amount of sodium chloride is significantly limited (food is prepared without salt). Avoid heavy, difficult-to-digest foods (meat and fish are served boiled), as well as foods that irritate the liver and kidneys, promote flatulence, and excite the nervous system, such as:

• fresh bread, butter and puff pastry products, pancakes, pancakes, cakes;
• legume soups, meat, fish, mushroom broths;
• sauces based on meat, fish, and mushroom broth;
• fatty meats, goose, duck, liver, kidneys, brains;
• smoked meats, sausages, canned meats;
• fatty, salted, smoked fish, caviar, canned fish;
• meat and cooking fats;
• salty and fatty cheeses;
• hard-boiled and fried eggs;
• salted, pickled, pickled vegetables;
• legumes, spinach, sorrel, radish, radishes, mushrooms;
• spicy, fatty and salty snacks;
• garlic, onions, mustard, pepper, horseradish;
• chocolate, natural coffee, cocoa;
• fruits with coarse fiber.

If the cause of renal colic is established, then during the attack, therapeutic nutrition is prescribed taking into account the underlying disease. Of course, concomitant pathologies (obesity, diabetes, hypertension, etc.) are also taken into account.

Therapeutic nutrition as a prevention of attacks of renal colic in urolithiasis (KD)

It has been statistically established that the risk of recurrent attacks with an established diagnosis of urolithiasis is about 80%.

Even surgical removal of stones cannot guarantee recovery, since the cause of the disease - the tendency to form stones in the upper urinary tract due to impaired metabolism - is not eliminated.

Therefore, the best prevention of new attacks is to find out the cause of stone formation and treatment. It should be remembered that inflammatory processes contribute to the formation of stones, so diseases such as pyelonephritis must be treated in a timely manner.

In addition, the water regime has a significant impact on the formation of stones, so the amount of liquid you drink, in the absence of contraindications, should be increased to 3-3.5 liters or more.

The risk of stone formation is significantly reduced by consuming so-called dietary fiber (DF) - substances of plant origin that are not exposed to digestive juices and are not absorbed.

The amount of PV required for the body can be compensated by daily consumption of wholemeal bread 100 g, beets - 30 g, carrots - 70 g, potatoes - 200 g, apples or pears - 100 g.

For urolithiasis, a properly selected diet is one of the best means of preventing renal colic. However, the composition of the stones must be confirmed in a laboratory, since poor nutrition can cause significant damage.

Diet for the prevention of renal colic caused by ICD with a tendency to form urates
If urolithiasis occurs with the formation of stones from uric acid (urates), then a diet that has an alkalizing effect on the urine is necessary.

Thus, if there are no additional indications, the N6 table, designed for patients suffering from gout, is well suited.

Diet for the prevention of renal colic caused by urolithiasis with a tendency to form oxalates
When oxalate stones form, they try to limit foods containing oxalic acid and increase the consumption of foods containing the calcium antagonist - magnesium. Products rich in magnesium include wheat and rye bran, wholemeal bread, oatmeal, buckwheat and pearl barley, millet, and dried fruits.

Based on the mechanism of development of the pathology, carbohydrates, salt, ascorbic acid, and gelatin are limited.

Thus, the following are prohibited:

• liver, kidneys, tongue, brains, salted fish, jellies and jellies on gelatin;
• meat, mushroom and fish broths and sauces;
• salty snacks, smoked meats, canned food, caviar;
• legumes;
• sorrel, spinach, rhubarb, mushrooms;
• pepper, mustard, horseradish;
• chocolate, cocoa, strong coffee.

With a combination of increased amounts of oxalates and calcium in the urine, as well as with a high alkaline reaction of urine and exacerbation of pyelonephritis, limit foods containing calcium (primarily milk and its derivatives).

Diet for the prevention of renal colic caused by urolithiasis with a tendency to phosphaturia
If the study showed the phosphorus-calcium nature of the stones, a tendency to phosphaturia and an alkaline reaction of urine, then it is necessary to increase the acidity of the urine by increasing the proportion of “sour” meat products.

In addition, it is necessary to limit foods that contain large amounts of phosphorus and calcium and have an alkalizing effect.