Renal colic signs and first aid. Cutting pains in the lower back, they are also renal colic: symptoms and causes in women

Quite often, patients learn about such a diagnosis as urolithiasis at the onset of renal colic syndrome, with which they enter the hospital by ambulance.

As a rule, until the movement of the formed stone along the urinary tract, the pathological process is absolutely asymptomatic. Although the patient's body is already experiencing quite severe metabolic disorders, patients do not even know that they have calculi and do not know what renal colic is.

Renal colic is a symptom complex that has a vivid clinical picture of what is happening, characterized by a severe attack of pain in the patient and changes in his urinary sediment (traces of blood appear in the urine, pathological impurities, etc.).

This condition is observed in people of different sexes and age groups. In children and pregnant women, renal colic is quite difficult, which requires a special approach from the doctor to relieve pain.

Renal colic, as a rule, is unbearable and begins suddenly (against the background of complete well-being). They completely deprive a person of his ability to work for a certain period of time, and if treated late, they can cause serious and dangerous complications.

Main reasons

In order for an attack of colic to develop, a violation of the outflow of urine is necessary, which leads to a reflex spasm of the smooth muscle fibers of the ureter and the appearance of a strong pain impulse in the cerebral cortex.

Stagnation of urine increases the pressure gradient in the pyelocaliceal apparatus of the affected kidney, which disrupts the processes of microcirculation and venous outflow in it. There is an increase in the parenchymal component of the organ and a stretching of the capsule, rich in nerve endings. This greatly increases the pain, and worsens the patient's well-being.

The causes of renal colic in more than 90% of cases are associated with the formation of stones at different stages of the urinary tract. It is with this disease that urological doctors most often have to deal with. The process is based on metabolic disorders, which leads to stone formation from urates, oxalates and other substances.

Among the predisposing factors, one way or another, affecting the onset of the ICD, it is necessary to highlight:

• genetic predisposition to metabolic disorders (more than half of the cases);
• work associated with heavy physical exertion, or intense sports, leading to dehydration;
• improper diet, a small amount of liquid consumed during the day;
• congenital defects of the urinary tract, leading to pathological stagnation of urine, etc.

An attack of renal colic can provoke any inflammatory process in the pyelocaliceal apparatus of the kidney, in which there is a violation of urine output due to a clot of pus that has closed the lumen of the duct (for example, against the background of acute pyelonephritis or exacerbation of its chronic form).

Destructive changes in the tissues of one or both kidneys can also cause the onset of a sudden pain syndrome. This is observed with a cancerous degeneration of an organ or a tuberculous process in it.

Against the background of oncology, normal tissues and walls of blood vessels are destroyed, which often leads to the closure of the lumen of the ureter or urethra with tumor fragments.

Severe traumatic effect on the organ (may cause a blood clot to enter the lumen of the urinary tract and clog them, for example, when falling from a height).

Compression of the ureters or urethra from the outside (growing oncological processes in the pelvis, massive hematoma, etc.).

Symptoms

As a rule, the initial manifestations of the process go unnoticed for the patient (if we are talking about the formation of stones). It is extremely rare that they pay attention to the fact that sometimes colitis or aches for no reason in the kidney area, until the disease begins to progress.

A typical and most striking symptom of the process that has begun is intense, often unbearable pain that occurs suddenly and is paroxysmal in nature (sometimes it is preceded by intense physical activity).

The pain is localized on the side of the obstruction of the ureter or excretory duct from the pyelocaliceal apparatus

The pain syndrome makes the patient toss and turn in bed in search of the most comfortable position that can reduce pain, however, these attempts are in vain. They are very excited and groan at the time of the attack.

If the calculus is localized in the lumen of the urethra, then the pain in the lower abdomen is diffuse. Dysuric disorders appear, the process of emptying the bladder is disturbed. Patients complain of pain during urination, and the desire to urinate becomes painful and constant.

A characteristic symptom of the process is the presence of blood in the urinary sediment (hematuria), the appearance of which is noted by the patient himself, because, as a rule, it is visible to the naked eye.

Characterized by irradiation of pain in the genitals, different parts of the abdomen, rectum, which is accompanied by painful urge to empty the intestines. Intestinal distention may occur, simulating the clinical picture of an acute abdomen.

At the peak of pain, attacks of nausea and vomiting appear, which do not relieve symptoms and do not bring relief to the patient. If the temperature rises to febrile values ​​\u200b\u200band higher, then this is direct evidence of the addition of bacterial flora, which can threaten the patient with a number of serious complications.

With spontaneous discharge of the calculus, the pain syndrome ends as suddenly as it began, which indicates the restoration of the outflow of urine.

Renal colic in children and pregnant women

Treatment of pathology in this category of patients is carried out only in a specialized hospital.

In children, stone formation is usually due to malnutrition and genetic predisposition. During pregnancy, those processes that previously proceeded latently are often activated, including urolithiasis.

Renal colic during pregnancy is often mistaken for the onset of preterm labor, especially if it occurs in the last stages, as a result of which a woman is mistakenly hospitalized in a maternity hospital. If urinary outflow disorders are observed in young children, then making a diagnosis can also be difficult, since babies cannot always explain what exactly worries them.

When choosing an anesthetic for renal colic in children and pregnant women, preference is given to the safest antispasmodics that are administered subcutaneously or intramuscularly (for example, No-shpa).

Complication

An unfavorable outcome is observed if the treatment of renal colic is late for one reason or another (for example, it hurts for a long time to stop pain attacks by taking large doses of painkillers and did not consult a doctor).

The complications of the process include:

• inflammation of one or both kidneys (obstructive pyelonephritis);
• cicatricial deformities of the affected ureter (development of strictures in it);
• septic condition of the patient (urosepsis) and others.

Cicatricial narrowing of the lumen of the ureter can be restored only by surgical intervention

Diagnostic principles

When a patient is admitted to a hospital, the doctor must very carefully collect an anamnesis of the disease from him. To do this, a question is asked about the presence of similar symptoms earlier, both in the patient himself and in his relatives (family history).

Subjective complaints are evaluated, because already on their basis a number of other pathological processes can be excluded. The characteristics of pain sensations, their exact localization and irradiation, what provokes them, and what, on the contrary, helps to stop renal colic, are asked in detail.

When examining a patient, the doctor performs palpation of the abdomen and pelvic organs. There is a sharp pain on the side of the lesion, that is, in the place where the blockage of the lumen of the ureter or urethra occurred. The abdomen is usually tense. When tapping on the lumbar region, a sharp pain occurs.

The main importance in differential diagnosis is given to methods of laboratory and instrumental research.

All patients are prescribed:

• blood test (general and biochemical);
• urinalysis and Nechiporenko test;
• overview x-ray and excretory (intravenous) urography;
• Ultrasound of the pelvic organs and urinary tract;
• CT or MRI of the urinary tract;
• other studies according to indications (diagnostic laparoscopy, etc.).

Diagnosis of the presence of kidney stones can be done using X-ray and ultrasound methods.

Principles of differential diagnosis

Unfortunately, there are no pathognomonic symptoms characteristic only for an attack of acute colic, so the process must be differentiated from a number of other diseases.

Below is a list of the main diseases that occur with symptoms resembling the clinic of renal colic:

• acute processes in the abdominal organs (inflammation of the appendix, acute cholecystitis or pancreatitis, peptic ulcer of the stomach or duodenum with perforation, intestinal obstruction);
• acute processes in the pelvic organs in women (inflammation of the fallopian tubes or ovaries, ectopic pregnancy and rupture of the tube, torsion of the cystic formation and necrosis of its legs, and others);
• inflammation of the urinary system (cystitis, urethritis, prostatitis and others);
• pathological processes of the organs of the cardiovascular system (attack of myocardial infarction, exfoliating aortic aneurysm);
• pain syndrome associated with diseases of the musculoskeletal system (intercostal neuralgia, osteochondrosis of the thoracic or lumbar spine, prolapsed hernia, and others).

Each of these conditions requires a thorough laboratory and instrumental examination of the patient.

If sudden pain occurs, it is necessary to call an ambulance as soon as possible, which will refer the patient to a hospital for further examination and specialized treatment.

It is worth saying about what you can not do with renal colic:

• for a long time to try to anesthetize discomfort on their own, taking huge doses of analgesic drugs from different pharmacological groups;
• heat the site of greatest pain if there is no certainty that the cause of the symptoms is related to the movement of the stone. Before the arrival of the medical team, you should do the following:
• it is necessary to calm down as much as possible and try to breathe deeply with each attack of pain;
• find a first-aid kit at home (for a while, analgesics and antispasmodics, or a combination of them, for example, Baralgin, will help relieve an unbearable attack of renal colic).

You can also take 2 tablets of No-shpy or Drotoverin. If there is a person with a medical education in the family, then their intramuscular administration is recommended.

When none of the above drugs is in the first-aid kit, then a Nitroglycerin tablet is used as an anesthetic, which is taken under the tongue until it is completely dissolved (cannot be chewed or washed down with water).

Specialized Emergency Therapy

In order to reduce the severity of pain as soon as possible, all drugs are administered intravenously, if this is not possible, intramuscularly.

Among the most common and effective painkillers, it is worth highlighting Ketorol, Diclofenac, Tramadol, Baralgin M and others.

Before the doctor begins to stop the attack of colic, it is necessary to tell him in detail about all the drugs and their dosages that were previously taken.

Antispasmodics in renal colic help fight the spastic component of the pathological condition, so their appointment is mandatory (No-shpa, Platifillin, Papaverine and others).

Relief of renal colic in a hospital

When a patient enters a specialized department, the basis of the patient's treatment is painkillers and antispasmodics. This continues until the stone passes or until the patient feels better.

If a patient has complications of an infectious nature against the background of the addition of bacterial agents, adequate antibiotic therapy is mandatory. Antibiotics are prescribed taking into account the microflora, which is sown in urine tests (protected penicillins, cephalosporins, macrolides, and others).

All patients are prescribed a salt-free diet, and they completely exclude from their diet all foods that can, in one way or another, influence the formation of stones (fatty meats and fish, confectionery, etc.). The choice of a specific type of diet depends on the type of stones (urate, oxalate and others).

Surgery

Further management of the patient directly depends on the size of the stones, their number, location, age of the patient, etc.

If an attack of colic is easily controlled, and the stone is small (up to 1 cm in diameter), and there is a possibility of natural discharge, then it is usually not touched. This is not an indication for surgical intervention, so the patient continues to be treated with conservative methods (they prescribe the necessary diet, prescribe drugs that help dissolve stones, etc.).

In the event that the severity of pain is unbearable, and there are signs of a violation of the kidney, immediately proceed to the operation.

The choice of surgical access is determined by the patient's condition and the specifics of the process (abdominal surgery, endoscopic intervention, etc.)

Conclusion

Every patient who has suffered an attack of renal colic associated with urolithiasis at least once in his life must continue to adhere to a number of rules and principles of nutrition. Even surgical removal of the stone does not guarantee the patient the complete absence of a recurrence of the disease.

Usually, by the time the first attack of renal colic occurs, a person already has an established diagnosis of urolithiasis or other urological disease. However, sometimes stones in the kidney do not make themselves felt for years. And an unexpected attack, provoked by the passage of a stone, a person takes for something else. After all, there are quite a few similar conditions. Therefore, it will be useful for all people to know the mechanism of development of renal colic, its symptoms and distinguishing features.

What is renal colic

Renal colic is an unexpected sharp pain in the ureter or in the kidney, which has a paroxysmal character, a special irradiation and is accompanied by digestive and urinary disorders. Its origin comes down to four main factors:

• stretching of the kidney cavity and its outer capsular membrane;
• irritation or compression of intrarenal nerve receptors;
• backflow of urine from the ureter into the pelvis (reflux);
• increased intrarenal pressure due to obstruction of the outflow of fluid from the kidney.

Renal colic is a consequence of acute blockage of the ureter. It is usually caused by the passage of a stone or accumulation of salt crystals through it. Colic is both right- and left-sided, while its course is the same and differs only in the direction of the spread of pain. Sometimes this phenomenon occurs simultaneously on both sides.

The cause of an attack in almost 90% of cases is urolithiasis. However, acute ureteral obstruction does not necessarily imply its presence. Blockage can occur during the movement of a purulent or blood clot through the urinary tract, as well as a fragment of a decomposing tumor. Sometimes attacks of colic are caused by a kink in the ureter when the kidney is lowered (nephroptosis).

Blockage of the ureter by a stone is the most common, but not the only, cause of renal colic.

Complete obstruction (overlap) occurs not only as a result of a mechanical obstruction. It can also be functional in nature: at the level of blockage, a spasm of the ureter appears. Since the contracted wall of the latter periodically relaxes, some of its permeability still remains.

Urine leaks between the foreign body and the inner surface of the ureter, as a result of which the pain decreases somewhat, but with the resumption of the spasm it becomes aggravated again. With a complete blockage of the outflow of urine, it takes on a constant cramping character and is accompanied by chaotic and unproductive pelvic contractions. This causes hydronephrotic expansion of the kidney cavity and overstretching of the outer shell of the organ.

As the foreign body moves down, another factor in the origin of the pain attack is added: direct irritation of the nerve endings of the ureter. When the calculus is localized in the upper or middle third of this hollow organ, discomfort spreads along its course. But as soon as the foreign object reaches the point of intersection of the ureteral tube with the common iliac artery, the pain begins to radiate to the suprapubic area and thigh.

The mechanism of pain irradiation is determined by the anatomical relationship between the common iliac artery and the ureter. These hollow organs are in close proximity to each other and are in close contact. Therefore, irritation of the nerve receptors of the ureter is transmitted to the mentioned blood vessel, and then to its continuation - the femoral (external) iliac artery on the side of the lesion. The irradiation of pain down the abdomen and into the suprapubic zone is due to the transmission of its impulses to the branches of the internal iliac artery.

Irradiation of pain: the difference between men and women

Throughout its length, except for the pelvic segment, the ureter in women is no different from that in men, except perhaps for a slightly shorter length. For both, the inner diameter of the lumen of this tube in different parts is from 6 to 15 mm.

Interestingly, the walls of the ureter have very good extensibility. Due to its elasticity, the organ is able to expand up to 80 mm in the lumen. This property helps a person survive renal colic and acute urinary retention associated with blockage of the ureter.

But in the pelvic part of women and men, the ureter has some anatomical features. In the former, it goes around the uterus from the side, passing along its wide ligament, is located behind the ovary and ends in the bladder at the level of the upper third of the vagina.

In the representatives of the stronger sex, the ureter goes forward and outward from the vas deferens. Having rounded the latter from the side, it flows into the bladder at a point located just above the upper edge of the seminal vesicle.

Until the stone has reached the pelvic region, the manifestations of renal colic in patients of both sexes are the same. With further downward movement, the calculus reaches the point of intersection of the ureter:

• in women - with a round ligament of the uterus;
• in men - with the vas deferens.

At this site of the "journey" of a foreign body along the urinary tract, the nature of the irradiation of pain becomes different. In women, it now radiates to the large genital lips, and in patients of the opposite sex, to the scrotum and testicle on the side of the lesion.

If the calculus managed to get into the bladder, then it begins to irritate the nerve receptors of the tissues in contact with the neck of this organ. Consequently, pain now spreads in the direction of the urethra: in females, they radiate to the vestibule of the vagina, and in male patients, to the head of the penis.

Features of renal colic in infants

Unfortunately, kidney disease sometimes does not spare even the smallest children. Babies in their first year of life can also have an attack of colic. They have some special features. Diagnosis is much more difficult, since the child, due to his early age, cannot indicate exactly where he hurts.

In infants, acute blockage of the lumen of the urinary tract with a stone is characterized by sudden anxiety. Pain in infants is concentrated in the navel. The child is actively moving, rushing about in the crib, kicking his legs, screaming piercingly.

Parents should be aware that the following signs indicate renal colic in a baby:

• severe bloating and tension in the abdomen;
• sharp pain when touched - when trying to stroke the stomach, the child cries out;
• breast rejection;
• repeated vomiting;
• prolonged absence of stool;
• increase in body temperature up to 38–39 o C.

Physicians explain the increase in body temperature (hyperthermia) by the occurrence of the reflux of urine from the renal pelvis into the general circulation - pyelovenous reflux. This fact has an irritating effect on the body's thermoregulatory center, which is the cause of hyperthermia. Having arisen in this way, it does not depend on the presence of bacteria in the urine.

In the case of penetration into the urinary tract of pathogens, the result of long-term renal colic in infants may be apostematous nephritis. This is a particularly dangerous type of acute inflammation of the kidneys, characterized by numerous abscesses (apostemes) in the parenchyma of the organ. Fortunately, in babies, the attack usually ends within 15 to 20 minutes.

Often the clinical picture of renal colic in infants is taken by parents for intestinal obstruction. To differentiate these two conditions, it is necessary to give the baby an enema. With renal colic, a large amount of feces is released along with the flushing fluid. With obstruction or volvulus of the intestines, on the contrary, it is not possible to obtain bowel movements with the help of an enema, but it is possible to secrete scarlet blood from the anus.

With surgical pathologies of the abdominal cavity, such as appendicitis or cholecystitis, the child tries to lie still on his back.

Video: why there is pain with renal colic

Typical symptoms in adults and the nature of pain

An attack of renal colic most often begins during significant physical exertion or movement of a person. Often the impetus for the discharge of the calculus is given by driving on a rough road, shaking. But an attack can occur without a provoking factor - at rest or even in a dream.

Passage of stones

The duration of the attack, depending on the speed of movement and the size of the foreign body, varies from 20 minutes to several days. If the stone is small and smooth, then the pain attack ends within 2-3 hours. The patient is most concerned about small acute-angled calculi: they are very mobile, move for a long time and easily injure the mucous membranes of the urinary tract.

Often, several small stones come out with urine during an attack of colic. After the departure of the first of them, temporary relief occurs, but with the beginning of the movement of the next, the pain resumes.

In some patients, stones are excreted painlessly.

Hematuria

With renal colic, an admixture of blood is observed in urine, sometimes quite intense; often with the naked eye, blood clots are visible in it. In a laboratory study of urine sediment, even if it visually has a normal color, an increased number of erythrocytes (red blood cells) is detected.

For renal colic due to urolithiasis, it is typical that the pain precedes the onset of bleeding and indicates the beginning of the migration of the calculus. With other urological pathologies, everything happens the other way around. First, a person develops hematuria, and later an attack of colic, provoked by blockage of the ureter with a large blood or purulent thrombus, joins it.

Gastrointestinal, general and dysuric disorders

Due to the fact that during colic there is irritation not only of the renal, but also of the celiac plexus, the typical symptoms of this condition are nausea and vomiting. There is bloating due to a delay in the passage of gases and stools.

The patient becomes pale, covered with a cold sweat. He has a fever, often accompanied by headache, weakness, dryness of the oral mucosa.

If a foreign body stops in the final (vesical) segment of the ureter, a person experiences frequent, painful and unproductive urge to urinate. During an attack of renal colic, sometimes there is even an acute retention of urine caused by blockage of solid foreign bodies in the urinary tract.

The nature of the pain

A large calculus, densely “settled” in the kidney, as a rule, does not interfere with the outflow of urine and does not cause renal colic. For the onset of an attack, incomplete occlusion of the ureter with a small stone or an accumulation of crystals of urinary salts is sufficient.

A painful attack with renal colic overtakes a person suddenly. Unbearable pain makes him rush about and change his position every minute in the hope of finding a position in which it will become smaller. Most often, the patient lies on his side with his knees pulled up to his stomach. Such restless behavior of the patient is explained by the fact that each new change of position for a short time brings some relief.

Sometimes a person during renal colic takes the most sophisticated, bizarre body positions. People say about such behavior "climbs the wall."

By the nature of the spread of pain, it is possible to approximately determine on which segment of the urinary tract the stone is currently located. The lower the foreign body moves along the ureter, the more intense the pain radiates to the leg on the side of the lesion and to the genitals.

While the obstruction is in the pelvis or in the upper segment of the ureter, the pain is localized in the lumbar region. But as soon as the stone descends into the lower segment of the urinary tract, it moves to the iliac or inguinal zone of the body.

Video: symptoms of renal colic

Diagnostics

Classical renal colic has a typical clinical picture, and its recognition for an experienced urologist is not particularly difficult. There are several methods to eliminate all doubts about the diagnosis.

Palpation and percussion

Healthy kidneys usually do not react in any way to their probing. With typical colic, two-handed palpation of the lumbar region intensifies the attack. During pressure on the abdominal wall in the direction of the affected ureter, a sharp pain is noted. With a quick flip of a person to the other side, an increase in painful sensations is also observed.

The classic manifestation of renal colic is Pasternatsky's symptom, which is revealed in this way: the examiner puts one hand on the patient's kidney area with the palm down, and gently but surely taps it with the edge of the second. If at the same time the pain intensifies, then Pasternatsky's symptom is considered positive. If the patient does not notice discomfort, the sign is negative. Often, after determining the positive symptom of Pasternatsky in a patient with renal colic, blood appears in the urine.

Laboratory research

Abnormalities in the results of laboratory analyzes of body fluids cannot be considered as a reliable sign of renal colic. Characteristic for her is only an increased number of erythrocytes (red blood cells) in the urine - hematuria.

Typical laboratory symptoms of the inflammatory process (increased ESR, shift of the leukocyte formula to the left, leukocytosis in the blood) are indirect and can be both in renal colic and in other acute diseases of the abdominal organs.

Changes in urine characteristic of urolithiasis during an attack of renal colic may not be observed due to complete blockage of the affected ureter by a foreign body.

Instrumental Methods

The decisive role in the recognition of renal colic belongs to urgently performed x-ray studies.

Plain radiography

First of all, the patient performs a simple survey radiography of the abdominal organs. Already at this stage, a shadow of a foreign body in the urinary tract is often detected, which makes it possible to make a diagnosis with almost 100% accuracy. However, the possibility of stones and blood clots in the veins or any inclusions in the intestines visible on the x-ray should be taken into account.

The presence of colic is indicated by an important radiographic sign - an area of ​​rarefaction surrounding the shadow of an enlarged kidney. It is the result of edema of the perirenal tissue.

Excretory urography

The second stage of instrumental diagnostics is excretory urography. In this case, the patient is administered intravenously with a radiopaque solution, which is excreted by the kidneys with urine and makes the urinary tract visible on the urograms. The method also allows you to distinguish the outlines of the stone in the pictures.

According to the results of excretory urography, the degree of impaired renal function is assessed. At the height of an attack of colic on the affected side, the organ may not work at all. However, there is an increase in the shadow of the diseased kidney due to the fact that its parenchyma is saturated with a contrast solution. This phenomenon suggests that the function of this organ is preserved and can be restored.

The urographic method reveals the secretion of a contrast agent by both kidneys. During an attack of colic on the affected side, there is an expansion of the pelvis and the upper part of the ureter. The lumen of the latter is filled with a contrast solution to the level of overlap with a calculus.

Differential Diagnosis

There are many conditions that mimic renal colic. Therefore, it is necessary to know their main distinguishing features. For example, a perforated stomach ulcer, appendicitis, acute diseases of the gallbladder and liver have to be distinguished from right-sided renal colic, pancreatitis from the left side, and inflammation of the female reproductive system from the bilateral side.

Unlike renal colic, other diseases with an "acute abdomen" clinic are distinguished by the patient's desire for peace, because the slightest movement increases pain. As they say, a person "lies in a layer" at the same time. And no matter how severe the pain in renal colic, the general condition of the patient suffers little. During it, there are no manifestations of general intoxication, typical for diffuse peritonitis.

Table: differential signs of renal colic and similar diseases

Prognosis and complications

If the stones are small and smooth (up to 6 mm in diameter), then in the vast majority of cases during renal colic they come out on their own, and there is no need for surgical aids. The prognosis is worse for large stones with spike-like growths.

In case of protracted, not relieved by medication pain attacks, to restore the outflow of urine in a hospital, one has to resort to catheterization of the urinary tract. In the most severe cases, with the ineffectiveness of all conservative measures, the patient is waiting for surgical intervention: dissection of the anterior abdominal wall and ureter with removal of the stone. Fortunately, this need is extremely rare.

The following factors directly affect the possibility of developing complications:

• the underlying disease that caused renal colic;
• the degree of overlap of the lumen of the ureter;
• the general condition of the patient's body and his age;
• timeliness and correctness of the provided pre-medical and medical care.

Bilateral obstruction of the ureters by stones can cause a complete stop of urination and anuria, lasting up to several days. The same complication can also occur when the outflow of urine is obstructed by a foreign body on only one side, accompanied by a reflex or nerve spasm of the second ureter. The condition of anuria is extremely life-threatening and requires emergency medical care.

The most common severe consequences of a prolonged attack of renal colic include:

• development of acute purulent pyelonephritis;
• uremic coma;
• septic shock;
• hydronephrosis and decreased kidney function;
• formation of cicatricial narrowing of the ureter.

After the attack is over, the patient feels better, but for some time he may experience a dull sensation of discomfort in the lumbar region.

Prevention

Prevention of the occurrence of renal colic consists in the exclusion of all possible risk factors, primarily urolithiasis. To avoid relapse, a person will have to stubborn, often long-term treatment of the underlying pathology that caused the attack.

• drinking plenty of fluids (2.5 liters of fluid per day) to keep urine in a dilute state;
• balanced diet;
• limiting salt intake;
• the use of urological herbal preparations, lingonberry and cranberry fruit drinks.

Video: how to prevent attacks of renal colic

The topic of anatomy, physiology and human health is interesting, loved and well studied by me since childhood. In my work I use information from the medical literature written by professors. I have my own extensive experience in the treatment and care of patients.

The occurrence of unbearable pain in the lower back, which does not leave the patient alone, makes him toss and turn in bed and makes it impossible 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 of the emergency conditions, 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, it is necessary to have reliable information regarding this pathological condition. This is exactly what will be presented in the article.

Basics of the structure of the human urinary system

It is rather difficult to understand the causes of renal colic and the basic principles of its therapy without having data on the process of urinary excretion. 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 exit from the kidneys. Quite often, stones are located precisely in the pelvis, since their lumen is rather narrow, only a few mm.

From the pelvis originates the next organ of the urinary system - the ureter. To put it quite simply, it is a hollow tube that communicates with the bladder and kidneys. The ureter is the second "favorite" place for the localization of stones. The diameter of the lumen of this organ is 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 excreted. This area most often rarely becomes the cause of an emergency.

The reasons

The development of colic can be provoked by various pathologies, but they are united by one common feature - obstruction (blockage) of the urine diversion pathways. Each of the pathologies leads to a violation 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 obturation? Today, the most common diseases are:

It is also necessary to highlight one important point - with the development of symptoms of renal colic after emergency care, it is necessary first of all to determine the absence / presence of a stone in the lumen of the pelvis or ureter. Only then can you proceed to the exclusion of other diseases.

Symptoms

For the diagnosis of this condition in a patient, only one symptom is enough - characteristic pain. In addition to pain, two more symptoms can join: a change in urination, vomiting. These are not necessarily manifestations of colic, but they are quite often observed in patients with such an emergency.

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 do not give rest, not allowing to sit or lie down normally, patients become overexcited, cannot find a place for themselves.

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

in the crotch;

on the anterior surface of the thigh;

renal colic in women radiates to the vagina and labia;

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

This symptom may be aggravated by probing the abdomen (in certain places, usually 3-5 cm on the sides of the navel) or tapping the lower back. The first symptom is optional 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 separated is quite small. The very process of urination is quite unpleasant, because there are cutting pains in the lower back and perineum. Due to trauma to the walls of organs and bleeding (small), urine often becomes reddish or pinkish.

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

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, vegetative disorders develop: general weakness, increased sweating, nausea, vomiting. The second mechanism is the disruption of the nerves of the solar plexus (at the location of the pain), as a result, the work of most of the digestive tract is disrupted.

Most often, vomiting is repeated and is in no way associated with the intake of water or food, it develops spontaneously. It does not help to cope with her attacks and taking a variety of sorbents (Smecta, Neosmectin, activated charcoal).

Can all symptoms abruptly recede? Yes, it is quite. The reason for spontaneous improvement is a change in the position of the stone and the normalization of urine outflow. In the case of a small calculus (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 occurrence, and you should not rely on it, it is better to seek specialized help as soon as possible.

Features of the course of renal colic in children

In a child, it is sometimes quite difficult to recognize the presence of this condition. Due to the peculiarities and mentality of the nervous system, the symptoms of renal colic most often differ from the well-known symptoms. In children, renal colic in most cases is manifested by widespread pain throughout the abdomen in combination with impaired urination and the presence of dyspeptic symptoms: constipation / loose stools, vomiting, flatulence, nausea. All these features lead to difficulties in diagnosis and misdiagnosis.

How to act in such cases? It is necessary to pay attention to the presence of dysuria. If this symptom is combined with abdominal pain, then it is necessary to exclude renal pathologies.

Treatment

Help with the development of renal colic should consist of two stages. The first is to relieve pain. It is very important to restore the normal outflow of urine and eliminate unpleasant sensations, not only to improve the patient's well-being, but also to maintain the efficiency of the kidney. After achieving this goal, you need to move on to the next step. This stage consists in the treatment of the pathology that led to the development of an emergency. This problem is dealt with by highly specialized specialists after the end of the acute period.

First aid

How to behave in case of renal colic at home? First of all, you should call an ambulance. Given the fact that the brigade will not be able to arrive instantly, you need to start alleviating the condition yourself. To do this, perform the following activities:

Warm up the lumbar region. The optimal effect will be given by a warm bath (water temperature in which is 38-40 degrees), since it does not affect a specific area, but the whole body. An alternative to a bath is a heating pad. But it is worth remembering that in case of suspicion of the presence of tuberculosis of the kidney, heat is contraindicated.

Give the patient pain medication. For these purposes, agents with a combined action 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 the usual 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 work. The combined effect of first aid measures allows you to slightly improve the patient's well-being before the arrival of a paramedic or doctor.

How to relieve pain in the absence of the effect of first aid? In such cases, the patient needs to perform a blockade - local anesthesia of the nerve and then, on an emergency basis, 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 the treatment of renal colic in a hospital. Unfortunately, not all patients agree to this proposal for personal reasons. This can lead to a lack of adequate therapy and a recurrence of an attack in the future.

But there is a group of patients for whom hospitalization is a vital measure. Even with the retreat of the acute period of pathology, you need to contact the hospital for help if the following conditions exist:

signs of a severe complication appear: pressure drop below 100/70 mm Hg. 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 above problems do not restore urinary function within a few hours, the result may be irreversible destruction of organs and even death.

Restoration of the outflow of urine

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

Percutaneous nephrostomy is most often an emergency treatment 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 on 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 the symptoms of colic.

Endoscopic stone removal is the most effective operation that 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 urination has been normalized, it makes sense to start treating the underlying pathology. If the patient was hospitalized, all the necessary diagnostics are performed in the hospital. In the case of outpatient treatment, the patient is referred to a local therapist.

Complications

If assistance is provided in a timely manner, the prognosis of the emergency condition is favorable. Complications can arise only with belated or erroneous treatment. The severity of such conditions can be different, it all depends on the condition of the patient and the duration of stagnation of urine. Among the most frequent complications are:

• persistent narrowing of the ureter;

  pyelonephritis - inflammation of the tissues of the kidney with their 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 pyelonephritis) are quite difficult to treat, but it is much easier to prevent - it is enough to contact a specialist for help.

FAQ

How is 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. In violation of the outflow of urine, which is always present when the calculus passes through the ureter, the solar plexus is irritated. Irritation leads to a reflex violation of the innervation of the gastrointestinal tract. This leads to nausea and vomiting, as well as bloating during an attack and the presence of constipation.

Why does the bladder always seem to be full, when there is very little urine produced when urinating?
This is due to the peculiarity of the structure of the human nervous system. In the process of passing the stone along the lower third of the ureter, irritation of the receptors occurs, which provokes false urges 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 gets stuck there most often.

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 is not always the case, some patients had a long train or car trip before the onset of the attack. Also, among the provoking factors, one should single out the intake 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. Also in practice, there are cases when the patient limited himself to liquids for a long time, and then drank a lot of water, which became the cause of the attack.

What is the mechanism of development of pain syndrome?

In the case of blockage of the ureter by a calculus, a violation of the process of outflow of urine occurs. 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 pyelocaliceal system of the kidney. Over time, the expansion increases and leads to compression of the vessels that feed the kidney, causing circulatory disorders.

It should be noted that the size of the macrolith 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.

Is it possible to confuse this condition with symptoms of other diseases?

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

acute pleurisy;

radiculitis;

kidney infarction;

ectopic pregnancy;

torsion of an ovarian cyst;

acute appendicitis in adults.

Accordingly, the obvious conclusion suggests itself - it is strictly forbidden to engage in independent treatment of this emergency condition. First you need to accurately determine the cause of the pain and conduct a differential diagnosis, and then move on to treatment, which is possible only in a hospital setting.

Can a stone reach the bladder and not come out of it?

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

What diagnostic methods are used for renal colic?

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

What does the physical examination of the patient show?

During the examination, pain is detected in the projection of the ureter and in the region of the kidneys. They also perform differential diagnosis with other acute surgical pathologies.

What is an ultrasound scan for?

This method is safe, relatively inexpensive and available. With the help of ultrasound, you can see the expansion of the pelvic space of the kidney, macroliths and stones in the ureter, determine the level at which the stone stopped. But this method is not always highly informative, with increased gas formation and obesity, visualization may be disturbed. Also, diagnosis can be difficult in the presence of some anomalies of the urinary system. Therefore, it is important not to dwell on one diagnostic method.

What does excretory urography show and what is it for?

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

What therapies are used?

If the patient has confirmed renal colic, then the 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 bring any effect, they proceed to remote lithotripsy or open surgery. The latter is rarely used today.

What is the essence of lithokinetic therapy?

If the stone is large and the probability of its independent exit 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 anesthetize), alpha-blockers (relax the smooth muscles that line the ureter), antispasmodics (expand the lumen of the ureter).

How long can a stone pass with lithokinetic therapy?

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

What is meant by remote lithotripsy?

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

What should be done if the soreness has disappeared, but the stone has not come out?

Stones must be removed even when they do not bother. If the stone remains in the ureter, but does not block the outflow of urine, trauma to the walls of the ureter continues. The outflow is disturbed, and the 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.

Renal colic is a complex of symptoms that occur when urine is difficult or impossible to drain from the kidneys. As a result, the renal pelvis fills with urine, its walls stretch under pressure, the smooth muscles of the ureters convulsively contract, causing spasms, the tissues swell, the blood vessels that feed the kidney narrow, and the kidney experiences a lack of oxygen, which only aggravates the situation. The person experiences severe pain. It is believed that pain in renal colic is one of the strongest that a person can experience, and surpasses even childbirth in intensity of exposure.

How does renal colic develop?

acute phase. Renal colic occurs suddenly. If the patient is asleep at this time, he wakes up from pain. If awake, then usually the patient can name the exact time of onset of renal colic. The occurrence of renal colic does not depend on physical activity, but a large amount of fluid drunk the day before, taking diuretics, stress experienced by a person, a bumpy road or a plentiful meal can contribute to its appearance.

The pain is constant and may worsen over time. Gradually, the intensity of pain increases, up to the apogee a few hours after the onset of renal colic. The level of pain depends on the individual sensitivity of the person, as well as the rate of increase in fluid pressure in the renal pelvis and ureter. If the frequency of contractions of the ureter increases, and the obstruction that caused the retention of urine moves, the pain may increase or resume.

constant phase. When the pain reaches its limit, it remains at this level for a long time. Usually this phase, which is very painful for the patient, lasts from one to four hours, but in some (fortunately quite rare) cases it can last up to twelve. As a rule, it is during the constant phase that patients go to the doctor or go to the hospital.

Decay phase. During this period, the pain decreases until it stops completely and the person finally feels better. The pain may stop at any time after the onset of renal colic.

Symptoms of renal colic

How to distinguish renal colic from pain caused by other diseases? The most important symptom of renal colic is the nature of the pain. Pain in renal colic always occurs unexpectedly, abruptly. First, a person feels an attack of pain in the side, lower back, or in the region of the lower ribs near the spine. Gradually, the pain intensifies, its localization changes: from the original place of occurrence, it goes down to the genitals, can affect the rectum and upper legs. Often, the lower the pain, the stronger it is. Patients often say that they feel constant pain with sharp and strong cramping attacks. A person is unable to find a position in which he would not experience pain, and is forced to walk back and forth even at a doctor's appointment. And the pain in renal colic is long, the attack can last from three to eighteen hours.

Depending on the disease causing renal colic symptoms accompanying it may vary. As a rule, patients experience frequent urge to urinate, while urine is either very small or absent, cutting pains are felt in the bladder and urethra. The patient's mouth dries up, he feels sick, vomits, but neither nausea nor vomiting brings relief. The pressure rises, the heart rate increases. As a result of the accumulation of gases in the intestines, the stomach swells, the patient experiences the urge to defecate. The temperature rises slightly, while a person may be chilled.

Very severe pain in renal colic can lead to the development of pain shock. At the same time, the patient turns pale, the frequency of heart beats decreases, cold sweat appears on the skin.

After the end of the pain attack, a large amount of urine is released. At the same time, due to the presence of blood in the urine, its color may become reddish. But even if the urine looks the most ordinary, traces of blood can be detected under a microscope.

Renal colic in children

Unlike adults, in young children, pain in renal colic is felt in the navel. The attack does not last long, 15-20 minutes, the child is frightened, cries, vomits, body temperature rises slightly.

Renal colicin pregnant women

Chronic diseases often worsen during pregnancy, and kidney disease is no exception. As a rule, in pregnant women, renal colic develops in the third trimester. The pain usually starts in the lower back and may radiate to the thighs and genitals. If renal colic occurs, you should immediately consult a doctor, as there is a risk of premature birth.

Causes of renal colic

One of the most common causes of renal colic is mechanical obstruction to the passage of urine. In most cases, a kidney calculus (stone) gets stuck in the ureter. With pyelonephritis, instead of a stone, the ureter is blocked by inflammation products - clots of mucus or pus, and with kidney tuberculosis - dead tissue. With nephroptosis, kidney dystopia, strictures, the ureter can twist, bend, or its lumen is so small that urine output is difficult. Sometimes the ureter can be affected from the outside, pinching it, tumors of the kidneys, ureter, prostate, as well as hematomas after trauma or surgery.

Sometimes renal colic occurs with inflammation of the urinary tract, for example, with hydronephrosis, periureterin, prostatitis, and so on. Renal vein thrombosis, renal infarction and embolism may also be accompanied by renal colic. And, of course, birth defects in the genitourinary system, caused by impaired development of the fetus in the womb, can also contribute to the development of renal colic.

When to Seek Medical Care for Colic

At the first symptoms of renal colic (especially if it occurs on the right side), it is recommended to immediately call an ambulance, otherwise there is a high risk of serious complications, up to the death of the kidney, the occurrence of chronic renal failure and even death of a person. It is advisable not to take medications at the same time, as they can blur the clinical picture and prevent the doctor from diagnosing the disease that caused renal colic.

Which doctor to go to for renal colic

First, the patient will be referred to a general practitioner, who, based on the results of the examination, sends the patient to specialists - a nephrologist or urologist. A nephrologist is consulted for kidney failure, urolithiasis, polycystic kidney disease, when surgery is not required, but it is enough to get by with medications. A urologist, on the other hand, is a more general specialist who deals with the entire genitourinary system and can apply surgical methods of treatment. In some cases, consultation with a gastroenterologist is required (if there is a suspicion of cholecystitis, peptic ulcer of the stomach or duodenum, gastritis) and a gynecologist (for inflammatory diseases of the small pelvis, ovarian cyst rupture and algomenorrhea).

Diagnosis of diseases that caused renal colic

Making a diagnosis of suspected renal colic is not an easy task. The medical literature provides evidence that only one quarter of the total number of patients admitted to the hospital with suspected renal colic suffers from it. In three quarters of cases, the cause of the pain is other diseases.

First of all, when making a diagnosis, the doctor interviews the patient, examines his medical history, measures temperature and blood pressure and conducts a medical examination, that is, palpation (palpation) and percussion (light tapping) of the abdomen, lower back, chest. One of the symptoms of renal colic is pain in the lumbar region and when tapping on the lower edge of the ribs on the right side. The intensity of pain depends on the stage of development of renal colic - when it is in an acute or constant stage, the feeling is strong, when it subsides - weak. And if the attack is over, the patient may not feel pain at all. Palpation will help to identify where the abdominal muscles are tense, indicating a pathological process in this place. In some cases, it is even possible to feel for an enlarged diseased kidney.

During the examination, the doctor may ask the following questions:

• When exactly did the pain start? (Pain in renal colic can appear suddenly, at any time of the day, and is weakly associated with a person's physical activity.)
• When does the pain go away? Does it reappear, and if so, after what time? (The pain of renal colic can come back at any time.)
• Where did the pain start? Where does it spread? (If the cause of renal colic is a mechanical blockage or compression of the ureters, then the pain is felt in this place. Subsequently, the pain may go down to the groin, genitals and inner thighs.)
• When does the pain increase and when does it decrease? (There are no alleviating factors for renal colic, a change in body position does not affect the degree of pain intensity, the pain may worsen with a large amount of liquid drunk.)
• Does the patient experience nausea or vomiting? (In renal colic, the patient vomits the contents of the stomach, vomiting does not bring relief.)
• What is the patient's blood pressure? (Usually, in the case of renal colic, the pressure rises.)
• What is the patient's temperature? (In renal colic, the temperature is usually slightly elevated, from 37° to 37.9°.)
• How is the process of urination? (Renal colic is characterized by difficulty urinating with painful sensations.)
• Does the patient or his immediate family suffer from urolithiasis? (In most cases renal colic caused by mechanical blockage of the ureters by stones or other formations.)

Diseases that can be confused with renal colic

Acute appendicitis. Most often, renal colic is confused with appendicitis, to the extent that 40% of patients suffering from kidney or ureteral stones underwent removal of the appendix. The reason for the errors is the proximity of the appendix to the right ureter. One of the main differences between renal colic and appendicitis is the nature of vomiting (with renal colic it occurs immediately, with appendicitis - after a long time after the onset of the disease) and the patient's position. If patients with appendicitis lie relatively still, then the patient with renal colic constantly changes body position in an attempt to relieve pain.

Hepatic colic. The percentage of errors in this case is less - those suffering from renal colic were treated for hepatic colic in 5% of cases. Colic renal, like hepatic, is characterized by sharp and severe pain that occurs in the same place. However, if in the case of renal colic it spreads down to the groin and genitals, then in hepatic colic it goes up and gives to the chest, shoulder blade and right shoulder. In addition, a doctor can easily establish a connection between dietary disorders and an attack of cholecystitis, while with renal colic, food does not directly affect its development.

Acute pancreatitis. When the stomach hurts and radiates to the back, to the lumbar region (where renal colic). Like pancreatitis, renal colic may be accompanied by flatulence and bloating, as well as nausea and vomiting. However, with pancreatitis, the pressure drops, while with renal colic it is normal.

Intestinal obstruction. This condition is easily confused with renal colic if it is complicated by bloating and flatulence. The main difference between intestinal obstruction and renal colic is the nature of the pain; with the latter, it is constant, and with the former, it is cramping and depends on the frequency of contractions of the intestinal muscles. The second difference is a high temperature with peritonitis that has developed as a result of obstruction, while with renal colic the temperature does not exceed 37.9 °.

Aneurysm of the abdominal aorta. With this disease, the stomach hurts, pain is given in the lumbar region. Like renal colic, an aneurysm may be accompanied by bloating, nausea, and vomiting. The difference is low, up to the possible development of shock, pressure with an aneurysm.

Shingles. Skin rashes characteristic of this viral disease do not appear immediately, which can make it difficult to make a diagnosis. With shingles, the pain does not change its location, unlike renal colic, which spreads to the lower body.

Lumbosacral sciatica. The nature of pain in sciatica is similar to renal colic - they are strong and sharp. However, the patient does not experience any nausea, vomiting, or urinary retention. And with renal colic, the intensity of pain does not depend on the position of the patient's body, as with sciatica.

Inflammation of the appendages. Often with this gynecological disease, pain radiates to the lower back, so that it can be confused with hepatic colic. However, unlike the latter, with inflammation of the appendages, a woman feels pain in the region of the sacrum and uterus, which the doctor can easily verify by palpation.

Tests and examinations for renal colic

Blood analysis. As a rule, usually with renal colic, an increased number of leukocytes is not observed in the blood (their presence rather indicates acute inflammatory processes occurring in the body). On the other hand, the content of urea in the blood serum may increase when, as a result of blockage of the upper urinary tract and the resulting increase in pressure, urine can enter the bloodstream.

It is also necessary to do a biochemical blood test to assess kidney function, degree of dehydration, acid-base balance, calcium and electrolytes. It is also worth checking the level of parathyroid hormones if hyperparathyroidism is suspected as the cause of hypercalcemia.

Analysis of urine. In the urine, blood clots, protein, salts, leukocytes, erythrocytes and epithelium can be detected. If the number of leukocytes is greater than the number of erythrocytes, then a urinary tract infection is possible.

In the vast majority of cases, with renal colic, there is blood in the urine, sometimes visible to the naked eye. However, if the ureter of a diseased kidney is blocked tightly, a urinalysis may be normal, because only urine from a healthy kidney enters the bladder. The time of development of hematuria (blood in the urine) can tell a lot about the cause of renal colic - if the blood in the urine appears after an attack of pain, then there is likely a mechanical obstruction in the ureter or pelvis. And if the blood appears before the onset of pain, then the tumor caused the renal colic.

A urine acidity level greater than 7.5 may indicate the presence of a bacterial infection and/or struvite stones, while an acidity level of less than 5.5 indicates the possibility of uric acid stones. If there are crystals in the urine, their type can be used to guess the presence and composition of kidney stones.

Daily urinalysis. With a daily urine test, all urine produced by a person within 24 hours (with the exception of the very first, morning portion) is poured into one large container, which is then sent for analysis. This method helps the doctor to determine which metabolic disorder caused the appearance of kidney stones and, as a result, renal colic, to determine whether stones remained after treatment, to determine kidney failure, or the presence of stones in both ureters.

X-ray of the abdominal cavity and urinary system. On an x-ray of the abdominal cavity, it is possible to determine whether the patient is suffering from acute abdominal pathology, intestinal pneumatosis, what pathological changes have occurred in the kidney - if the kidney is sick, it usually looks darker in the picture than healthy. Edema of the kidney can be determined by the presence of a clear line separating the shadow of the kidney from the perirenal tissues. In the vast majority of cases, the presence of stones can be seen in the picture (the exception is if the stones consist of uric acid or cystine crystals).

Intravenous urography. During this examination, the patient is placed on an x-ray table, where a radiopaque substance is injected into a vein. Then, after a time specified by the doctor, a series of x-rays is taken. Sometimes the patient is asked to rise to his feet and take pictures in a standing position.

Urography is indispensable for assessing the functioning of the kidneys (this is evident from the rate of excretion of the contrast agent), determining changes in the structure of the kidney, the contours of the calyces and pelvis, the patency and function of the ureters. Allows you to determine the presence of nephrolithiasis, stones, hydronephrosis and other diseases that caused renal colic. Works great in tandem with an abdominal x-ray and allows you to find which organ system a suspicious darkening in the picture belongs to.

True, urography has one big drawback - the contrast agent used can cause allergic reactions and even impaired kidney function.

Chromocystoscopy. With chromocystoscopy, the doctor first examines the condition of the mucous membrane of the urinary tract, bladder and ureters using a cytoscope. Then the patient is injected intravenously or intramuscularly with medical indigo carmine. The drug is completely harmless; the only thing it does is turn the urine blue. Then the doctor again takes the cytoscope and assesses how long the paint will appear in the ureter and bladder, how exactly the colored urine enters the ureter and the general condition of the ureteral orifices. As a rule, with violations of the functioning of the kidney, the appearance of colored urine may be delayed; delays of more than 15 minutes can indicate serious kidney problems, such as swelling, a stuck stone, or hemorrhage. Although chromocystoscopy does not require special equipment, is easy to perform, and is safe for the patient, it is quite painful, so it is performed under anesthesia.

Ultrasound of the kidneys and bladder. It allows you to determine the condition of the urinary tract, the degree of expansion of the ureters and renal pelvis, the condition of the renal tissue, and also to find out if the patient has stones in the kidneys and ureters, what size they are and where they are located. True, if the stones are located in the middle third of the ureter, it is more difficult to determine their presence using ultrasound because of the pelvic bones that interfere with the review.

Ultrasound of the abdomen and pelvis. It is carried out if there is a suspicion of an acute abdomen - a set of symptoms indicating serious diseases of the internal organs of the abdominal cavity. The cause of the condition can be appendicitis, perforation of a stomach ulcer, rupture of the intestine after an injury, ectopic pregnancy, and so on. An acute abdomen is an indication for immediate surgery.

CT scan. If neither X-ray studies nor ultrasound help determine whether there are kidney stones in the patient's body, one can resort to computed tomography of the retroperitoneum and pelvis. With it, instead of the usual two-dimensional image, a three-dimensional image of the patient's body is modeled, and the doctor has the opportunity to examine the affected area of ​​\u200b\u200bthe organ from different angles. The degree of reliability of CT is very high, so CT is often used in complex cases or when planning surgery.

Urolithiasis as one of the most common causes of renal colic

Kidney stone disease (nephrolithiasis or urolithiasis) is a common disease that affects 5 to 15% of the population. It is caused by kidney stones, or calculi, which, if stuck, descending from the kidney through the ureters, can cause a person to have renal colic. ICD is highly recurrent - about half of the total number of patients is prone to re-formation of stones if they do not engage in the prevention of the disease. More than 70% of cases of renal colic caused by stones occur in people from 20 to 50 years old, in men more often than in women (ratio 2 to 1). There are several prerequisites for the possible formation of stones.

The most frequent of them are the following:

• Insufficient urine output. If the amount of urine produced by the patient is not more than 1 liter per day, the urine becomes more concentrated, may stagnate, which leads to its supersaturation with dissolved substances and, as a result, the formation of stones.
• Hypercalciuria. The reasons for its occurrence have not yet been studied. It is assumed that this condition may be due to increased absorption of calcium in the blood, an increase in its level in the blood, hypervitaminosis D, hyperparathyroidism, eating a diet high in protein, or systemic acidosis. Hypercalciuria increases the saturation of the urine with calcium salts such as oxalates and phosphates, leading to the formation of crystals. Approximately 80% of kidney stones contain calcium.
• Elevated levels of uric acid, oxalate, sodium urate, or cystine in the urine. Stones with salts of uric acid make up 5 to 10% of all kidney stones. Often this urine composition is the result of a diet high in protein, salts and oxalic acid esters (oxalates), or a genetic disorder causing increased excretion.
• Infection. It is caused by urea-degrading bacteria (Proteus or Klebsiella species). They break down urea in the urine, thereby increasing the concentration of ammonia and phosphorus, which contribute to the formation and growth of stones. Stones of this type are called mixed (because they contain magnesium, ammonium and calcium phosphates).
• Insufficient levels of citric acid salts (citrates) in the urine. The role of citrates in the urine is similar to the role of bicarbonates in the blood serum. They lower the acidity of the urine, but also slow down the growth and formation of crystals. The optimal level of citrates in the urine is 250 mg/l to 300 mg/l.
• Obesity, hypertension, diabetes. All these diseases contribute to the formation of kidney stones and, as a result, the appearance of renal colic in humans.

Complications of renal colic

As the stone moves out of the pelvicalyceal system, it can injure the ureter, thereby contributing to the formation of strictures in it, blocking it and causing hydronephrosis and an attack of renal colic, reduce the rate of peristalsis of the ureter, and contribute to the return and stagnation of urine in the kidneys. This, in turn, leads to a decrease in the glomerular filtration rate of urine by the affected kidney and an increase in the load on the healthy one. Complete blockage of the ureter cause a state of acute renal failure. If left untreated within one to two weeks, the damage may be irreversible. Additionally, there is a risk of rupture of the renal calyx with the development of urinoma (urinary pseudocyst, when the urine is surrounded by a fibrous capsule and looks like a tumor). An infection that has entered the affected kidney can cause even more concern, which as a result leads to obstructive pyelonephritis (occurs in about a quarter of the total number of cases of renal colic) or purulent inflammation of the kidneys, pyonephrosis. In severe cases, urosepsis can develop, which can be fatal.

Prognosis for renal colic

Conditionally favorable, if the patient went to the doctor after the first symptoms of renal colic, and the disease that caused it had no complications. Otherwise, it all depends on the severity of the disease, the age and condition of the patient.

Emergency hospitalization for renal colic

The patient must be urgently sent to the hospital if, despite all efforts, it is not possible to reduce the pain of renal colic, the patient has both kidneys affected or only one is available, when exudate is released (fluid that enters the tissues from the blood vessels during inflammation), hypercalcemic crisis.

Also, urgent treatment is necessary if the stone that clogged the ureter is infected. Such a stone acts as a focus of infection and causes stagnation of urine, which reduces the patient's chances to somehow resist the infection. Such stones must be removed immediately and completely to prevent re-infection and the formation of new stones.

Treatment of renal colic

In the treatment of renal colic, the doctor has two tasks: first, it is required to relieve pain; secondly, to cure the disease that caused the occurrence of renal colic, and normalize the functioning of the urinary system.

Medications to relieve pain in renal colic

• thermal procedures. Pain in renal colic can be reduced by applying a warm compress, a warm heating pad to the lower back or abdomen. The patient can make a sitz bath with water above body temperature (up to 39 °) for 10-15 minutes. Attention! If renal colic is accompanied by inflammatory processes in the body, for example, pyelonephritis, then thermal procedures cannot be carried out - they can only worsen the situation.
• Medicines. To reduce urinary tract spasm, relieve the pain caused by it, and resume the passage of urine, the doctor may suggest that the patient take painkillers - non-steroidal analgesics or, in case of severe pain, opiates. The use of non-steroidal analgesics can kill two birds with one stone. First, they reduce the release of arachidonic acid derivatives, which mediate pain receptors, which can relieve pain from stretching the walls of the renal capsule. Also, non-steroidal analgesics lead to a decrease in glomerular filtration and a decrease in fluid pressure on the glomerulus. Since patients often cannot take drugs orally due to pain and vomiting, they may be given intravenous or intramuscular painkillers - for example, Revalgin (metamisole sodium, pitofenone, fenpiverinium bromide), ketorolac, atropine, drotaverine, analgin with platifillin and other. For severe pain, opiates, such as morphine sulfate, may be used. However, they should be used with caution - in addition to respiratory depression and sedation, the patient may develop dependence. In the future, when his situation improves, the patient can take some drugs on his own, for example, spazdolzin in the form of suppositories, cystenal on sugar under the tongue, cystone tablets, and so on.
• With severe pain, the doctor can block the spermatic cord in men or the round connection of the uterus in women, when a novocaine solution is injected into the affected organ with a syringe into the affected organ. Pararenal blockade, when novocaine solution is injected into the perirenal tissue, is not recommended for renal colic - it can only further injure the kidney and make it difficult to work. If the pain persists even after the blockade, the patient must be urgently taken to the hospital.
• Catheterization of the ureter. If the patient failed to relieve the patient with drugs, catheterization of the ureter is indicated. If you managed to bring the catheter to the obstruction that clogged the ureter and bypass it, you can immediately remove the accumulated urine, which immediately brings relief to the patient and relieves renal colic. Antibiotics should be given to the patient to prevent infection.

Treatment of the disease that caused renal colic

It is selected by the doctor individually, depending on the disease that caused renal colic and the patient's condition. If the cause is a blockage of the ureter, the obstruction can be removed with medication (dissolve or force it to come out on its own). If this is not possible, remote shock wave lithotripsy (when the shock waves destroy the obstruction, and the remaining small particles from it are excreted in the urine on their own), contact lithotripsy (destruction of the stone with the help of an endoscope) or percutaneous nephrolithotripsy (when the endoscope is inserted through a tiny incision in the skin ).

If renal colic is caused by a bend in the ureter when the kidney is lowered (nephroptosis), in the early stages of the disease, the patient is recommended to wear a bandage to prevent displacement of the kidney, and to exercise to strengthen the muscular frame. If these measures do not help or the situation is complicated by pyelonephritis, stones and arterial hypertension, the kidney is returned to its place surgically.

A stricture (narrowing of the canal) of the ureter can only be corrected with surgery. If the stricture is small, it is removed by endoscopic surgery. If a blood vessel is pressing against the ureter, the doctor may, during laparoscopic surgery, cut the ureter, move the vessel to its posterior surface, and reseat the ureter. If the affected areas are so large that their excision is impossible, the affected fragments are replaced with fragments of the patient's own intestinal tissues.

For tumors in the abdominal cavity, one of the consequences of which is a kink or twisting of the ureter and renal colic, surgical treatment is indicated. If the tumor is benign, it is removed so that it does not undergo malignancy (i.e., so that benign cells do not turn into malignant ones). For large tumors, a combination of surgery and radiation therapy is used, and if the cancer cannot be removed by surgery, chemotherapy is used.

Outpatient treatment for renal colic

Young and middle-aged people can be treated at home and visit a doctor on their own, if their condition is generally stable and does not cause concern, renal colic is without complications, the pain is not severe, the body's response to the administration of painkillers is good. And, of course, the patient must be able to regularly travel from home to the hospital.

In this case, the patient should follow the home regime, as necessary, carry out thermal procedures to relieve pain (heating pad, hot bath). Particular attention should be paid to the condition of the genitourinary system - visit the toilet in a timely manner, try to completely empty the bladder, wash your hands with soap and water before and after visiting the toilet. The patient should urinate into the container from time to time and look at it for stones in the urine. Another requirement is to strictly observe the diet indicated by the doctor. Usually, with renal colic, treatment table No. 10 or No. 6 is prescribed.

It is not recommended to take several analgesic drugs at the same time - they can enhance each other's side effects. If anuria (urinary retention) is observed, one should not try to stimulate urination and drink a diuretic - this can only provoke a new attack of renal colic.

If the patient again feels pain with renal colic, the temperature rises, he feels sick, vomits, urination is difficult, and the general situation worsens, an ambulance should be called immediately.

Rehabilitation and prevention of renal colic

After the relief of an attack of pain in renal colic and the treatment of the disease that caused it, the rehabilitation process begins. Its method is selected by the doctor for the patient, based on the nature of the disease, the age and condition of the patient, the presence of complications in the disease and pathological changes in the body. But for any diseases of the genitourinary system, it is recommended to visit a urologist or nephrologist at least once a year for a preventive examination, take a urine test and do an ultrasound of the pelvic organs. For patients who have undergone tumor removal, this is especially important.

Diet plays an important role in preventing the recurrence of stones, which can cause a new attack of renal colic. One of its main conditions is the use of fluid in a volume of at least 2.5 liters per day, which can significantly reduce the concentration of salts in the urine. As a rule, the diet reduces the consumption of animal proteins, sweets, fats, salt. Depending on the type of kidney stone, your doctor may further limit foods that contain substances that promote the formation of this type of stone, such as oxalates (found in apricots, tomatoes, cornmeal, etc.) or purines (beer, legumes, liver, yeast). A patient who has undergone pyelonephritis is advised to refuse to eat fried, fatty, baked foods, dishes with a high content of salt and spices, as well as fresh bread.

With nephroptosis, the patient is recommended to follow a diet so that sudden changes in weight do not lead to a relapse of the disease, and also to strengthen the muscular frame with regular exercise. It is usually recommended to follow diet number 7 and individually adjust it for yourself. With nephroptosis, it is important to get enough calories so that the lack of body fat does not cause a new descent of the kidney and another renal colic.

Separately, it is necessary to mention that after an attack of renal colic, when the ureter occlusion 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 also sand can be seen in the urine. Occasionally, individual small stones may be passed out with the urine, a process sometimes referred to as "stone birth". In this case, the passage of a stone through the urethra can be accompanied by significant pain.

Diagnosis of renal colic

It must be understood 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 more rational treatment and prevent ( or delay) repeated exacerbations. Differential diagnosis is necessary in order not to confuse this pathology with others with a similar clinical picture ( acute appendicitis, hepatic or intestinal colic, perforated ulcer, thrombosis of mesenteric vessels, adnexitis, pancreatitis), and prevent improper 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, a doctor of almost any specialty can provide adequate assistance. However, as mentioned above, due to the need to differentiate this disease from other dangerous pathologies, first of all, you should 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 of all if renal colic is suspected.

If renal colic occurs, it makes sense to call an ambulance, as this will allow earlier treatment to eliminate pain and spasm, as well as 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 be provided with the most qualified assistance.

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

• interview;
• clinical examination;
• ultrasound procedure;
• X-ray methods of research;
• laboratory study of urine.

Interview

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 verbal description of the patient. For the diagnosis of renal colic, the time of onset of pain, its nature ( sharp, dull, aching, constant, paroxysmal), the place of its distribution, the change in its intensity when changing the position of the body and when taking painkillers.
• Nausea, vomiting. Nausea is also a subjective sensation, which the doctor can learn about only from the patient's words. The doctor needs to be informed when nausea appeared, whether it is associated with food intake, whether it is aggravated in some situations. It is also necessary to report episodes of vomiting, if any, their relationship with food intake, changes in the general condition after vomiting.
• Chills, fever. 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 if there are any changes in the act of urination, if there is an increased urge to urinate, if there was a discharge of blood or pus along with urine.
• The presence of attacks of renal colic in the past. The doctor should find out whether this attack is a new one or if there have been episodes of renal colic before.
• The presence of a diagnosed urolithiasis. It is necessary to inform the doctor about the fact of the presence of urolithiasis ( if there is one now, or was in the past).
• Diseases of the kidneys and urinary tract. The fact of having any pathologies of the kidneys or urinary tract increases the likelihood of renal colic.
• Operations or injuries of the organs of the urinary system or the lumbar region. It is necessary to inform the doctor about the surgeries and injuries of 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 rules out acute appendicitis in the present).
• Allergic reactions. Be sure to tell your doctor if you have any allergic reactions.

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

Clinical examination

During a clinical examination, it is necessary to undress in order for the doctor to be able to assess the general and local condition of the patient. To assess the condition of the kidneys, their percussion can be performed - a light tapping of the hand on the back in the region of the twelfth rib. Pain experienced during this procedure symptom of Pasternatsky) 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 during an attack can be tense). The kidneys are rarely palpable during this procedure ( sometimes only their lower pole), however, if it was possible to palpate them completely, then this indicates either their omission or a significant increase in their size.

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

Ultrasound procedure

Ultrasound without prior preparation may be less sensitive, but in emergency cases where urgent diagnosis is needed, the information obtained is 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 the x-ray.

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

• expansion of the pelvicalyceal system;
• an increase in the size of the kidney by more than 20 mm compared to the other 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 methods of research

Radiation diagnosis of renal colic includes:

• Plain x-ray of the abdomen. An overview picture of the abdomen allows you to visualize the area of ​​​​the kidneys, ureters, bladder, as well as the condition of the intestines. However, only X-ray positive stones can be detected using this research method ( 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 the circulation in the kidneys, evaluate the function of filtration and concentration of urine, as well as monitor the excretion of urine through the pelvicalyceal 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 picture. This method allows diagnosing blockage at any level of the ureter, regardless of the composition of the stone.
• CT scan. Computed tomography creates images that help assess 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-like ( 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 cost, CT scans are only used when absolutely necessary.

Excretory urography is carried out only after complete relief of renal colic, since at the height of the attack, not only does the outflow of urine stop, but the blood supply to the kidney is also disturbed, 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, with urolithiasis, with the detection of blood impurities in the urine, with 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 to a contrast agent;
• patients with myelomatosis;
• with a blood creatinine level above 200 mmol / l.

Laboratory study of urine

In a laboratory study, analysis of morning urine is carried out ( which accumulated in the bladder during the night, and the analysis of which allows one to objectively judge the composition of impurities) and daily urine ( which is collected during the day, and the analysis of which allows you to evaluate the functional ability of the kidneys).

In a laboratory study of urine, the following indicators are evaluated:

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

It is extremely important to analyze the chemical composition of the calculus ( 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 arrival of the ambulance can reduce spasm of the smooth muscles of the ureter, which helps to 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 to the abdomen on the side of the lesion.
• Drugs that relax smooth muscles(antispasmodics). Taking drugs 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 with 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 lubricate the clinical picture and make diagnosis difficult. To relieve pain at home, you can use ibuprofen, paracetamol, baralgin, ketanov.

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

For the treatment of 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

Antiemetics

Drugs that reduce urine production

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

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, drugs alkalizing urine are used.

Drugs used to dissolve uric acid stones

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

Surgery

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

• complicated urolithiasis;
• hydronephrosis of the kidney dropsy of the kidney);
• wrinkling of the kidney;
• ineffectiveness of medical treatment;
• stones larger than 1 cm in diameter that cannot pass on their own.

Stones can be removed in the following ways:

1. remote lithotripsy;
2. contact lithotripsy;
3. percutaneous nephrolithotomy;
4. endoscopic stone removal;
5. stenting of the ureter;
6. open kidney surgery.

This method of destruction of stones is used when stones are less than 2 cm in size and located in the upper or middle part of the pelvis.

Remote lithotripsy is contraindicated in the following situations:

• blood clotting 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) of the 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 stone using fluoroscopic examination.

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

Ureteral stenting
Ureteral stenting involves the introduction of a special cylindrical frame by endoscopic means, 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 stone removal, which is practically not used at the moment. This surgical intervention can be used with significant damage to the kidney, with its purulent-necrotic change, as well as with massive stones that are not amenable to lithotripsy.

Preparation for surgical removal of stones involves the following activities:

• Delivery of analyses. Before performing a surgical intervention, it is necessary to pass a general urinalysis and a general blood test, do a fluorography, conduct an ultrasound and x-ray examination of the kidneys.
• Therapist's consultation. To exclude possible contraindications and systemic pathologies, it is necessary to consult a therapist.
• Diet. Proper diet allows you to avoid excess gas and accumulation of feces in the intestines, which greatly simplifies the intervention. To do this, a few days before the operation, it is necessary to abandon sour-milk products, fresh vegetables, and legumes. No food is allowed on the day of the procedure.

Treatment with folk remedies

The following remedies can be used to treat renal colic:

• Hot tub. As mentioned above, hot water helps to relax the smooth muscles of the ureter. 10 g can be added to water ( 2 tablespoons) grass cudweed, sage leaves, birch leaves, chamomile and linden flowers.
• Medicinal infusion. Six tablespoons of a mixture of birch leaves, harrow root, juniper fruit and mint leaves must be poured with 1 liter of boiling water and infused 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 must be poured with 5 glasses of water and boiled for 20 minutes in a water bath. Consume hot for 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 grass, parsley root and calamus rhizomes are poured with a glass of boiling water and boiled for 10 minutes in a water bath. It is used 70 - 100 ml three times a day for 20 - 40 minutes before meals.
• Decoction of barberry. Two tablespoons of barberry fruits, juniper, shepherd's purse herb, steel root are poured with a glass of boiling water and boiled for a quarter of an hour, after which they insist 4 hours. It is consumed 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 grass, rose hips are placed in 1.5 cups of boiling water and infused for an hour. Used 70 - 100 ml 3 times a day before meals.

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

• A decoction of barberry flowers. Two tablespoons of a mixture of barberry flowers, immortelle flowers, lingonberry leaves, black elderberry flowers, sweet clover grass, motherwort herb are poured with a glass of boiling water, boiled in a water bath for 10 minutes and infused for 2 hours. Consume 50 ml 3 times a day before meals.
• A decoction of budry grass. Two tablespoons of budra grass, blue cornflower flowers, wintergreen leaves, peppermint leaves are poured with one and a half cups of boiling water, boiled for 5 minutes and infused for an hour. Use 50 ml 4 times a day before meals.
• A decoction of immortelle flowers. Two tablespoons of a mixture of immortelle flowers, budra grass, black elder 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 infused for 4 hours. Use in a warm form, 50 ml 4 times a day before meals.

Prevention of renal colic

What do we have to do?

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

What should be avoided?

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, 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, vegetables.
• Uric acid stones. With the formation of uric acid stones, it is necessary to reduce the intake of uric acid, which is found in meat products, smoked meats, legumes, coffee and chocolate.

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