What is renal colic in women. Renal colic - causes, symptoms, diagnosis, treatment, diet. Medications to relieve pain in renal colic

Chills occur in the case of a sharp increase in pressure in the renal pelvis, which leads to the development of pyelovenous reflux ( reverse current blood and urine from the pelvis and calyces of the kidney into the venous network). The entry of decay products into the blood leads to an increase in body temperature to 37 - 37.5 degrees, which is accompanied by a tremendous chill.

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

In most cases, for a competent specialist, the diagnosis of renal colic is not difficult. This ailment is assumed even during a conversation with a doctor ( which in some cases is sufficient for diagnosis and initiation of treatment), and is confirmed by inspection and a series of instrumental and laboratory tests.

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.

In connection with a pronounced pain syndrome, which forms the basis of the clinical picture of renal colic, people with this disease are forced to apply for medical assistance. 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. Precisely to this specialist should be treated first if renal colic is suspected.

When renal colic occurs, it makes sense to call 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 physician medical care 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:

survey;
clinical examination;
ultrasonography;
X-ray methods of research;
laboratory study of urine.

Survey

Correctly collected data on the disease suggest renal colic and possible reasons its occurrence. During a conversation with a doctor, special attention is paid to the symptoms and their subjective perception, risk factors, as well as comorbidities.

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 temperature body ( 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.

The following data may be required to determine risk factors:

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

In addition, depending on the specific clinical situation, other data may be required, such as, for example, the date of the last menstrual period ( to rule out ectopic pregnancy), chair characteristic ( to rule out intestinal obstruction), social conditions, bad habits and much more.

Clinical examination

The clinical examination for renal colic provides little information, but when combined with a well-conducted interview, it may suggest renal colic or its cause.

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 rectum.

Ultrasonography

Ultrasonography ( ultrasound) is an extremely informative method of non-invasive diagnostics, which is based on the use of ultrasonic waves. These waves are able to penetrate the tissues of the body and reflect from dense structures or the boundary between two media with different acoustic resistance. The reflected waves are recorded by a sensor that measures their speed and amplitude. Based on these data, an image is built that allows you to judge the structural state of the organ.

Since many factors affect the quality of an ultrasound image ( intestinal gases, subcutaneous fat, bladder fluid) it is recommended to pre-prepare for this procedure. To do this, a few days before the examination, exclude milk, potatoes, cabbage, raw vegetables and fruits from the diet, and also take Activated carbon or other drugs that reduce gas formation. Drinking regimen can not be limited.

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 diagnostics renal colic is represented by three main research methods based on the use of x-rays.

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.

Despite the shortcomings of the overview X-ray image, during an attack of acute renal colic, it is he who is done first of all, since in the vast majority of cases the stones formed in the kidneys are X-ray positive.

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 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

A laboratory study of urine is an extremely important research method for renal colic, since changes in urine always occur with this disease ( which, however, may not be present during an attack, but which appear after its relief). A general urine test allows you to determine the amount and type of impurities in the urine, identify some salts and fragments of stones, and evaluate the excretory function of the kidneys.

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 us to evaluate functional ability kidney).

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).

With renal colic and urolithiasis, a high content of calcium salts, oxalates and other stone-forming substances, blood and pus impurities, and a change in the reaction of urine can be detected.

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

The goal of treating renal colic is to eliminate pain and spasm of the urinary tract, restore urine flow, and eliminate the root cause of the disease.

First aid for renal colic

Before the arrival of doctors, you can perform a number of procedures and take some medicines, which will help reduce pain and slightly improve the general condition. In this case, one should be guided by the principle of least harm, that is, it is necessary to use only those means that will not aggravate or cause complications for the course of the disease. Preference should be given to non-drug methods, as they have the fewest side effects.

In order to alleviate the suffering of renal colic before the arrival of an ambulance, the following measures can be used:

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 main treatment for renal colic should be done in a hospital. At the same time, in some cases, there is no need for hospitalization, since the passage of the stone and the restoration of the outflow of urine allow us to talk about positive dynamics. However, within one to three days, monitoring and monitoring of the patient's condition is carried out, especially if there is a possibility of re-development of renal colic or if there are signs of kidney damage.

The following categories of patients are subject to mandatory hospitalization:

who don't have 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 medicines that can relieve 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

Pharmacological group	Main Representatives
Non-steroidal anti-inflammatory drugs	Ketorolac	Intramuscular injections at a dose of 60 mg every 6 to 8 hours for no more than 5 days ( until the pain stops)
Non-steroidal anti-inflammatory drugs	Diclofenac	Intramuscular injections at a dose of 75 - 100 mg per day with a further transition to tablets
Non-narcotic painkillers	Paracetamol	Inside at a dose of 500 - 1000 mg. Often used in combination with narcotic painkillers, as it enhances their effect.
Non-narcotic painkillers	Baralgin	Intravenously or intramuscularly, 5 ml every 6 to 8 hours as needed.
Narcotic pain relievers	Tramadol Omnopon Morphine Codeine	The dose is set individually depending on the severity of the pain syndrome ( usually 1 ml of 1% solution). To prevent smooth muscle spasm, it is prescribed in combination with atropine at a dose of 1 ml of a 0.1% solution.
Local anesthetics	Lidocaine Novocaine	By these means, a local blockade of the nerve is carried out in order to interrupt the transmission of the pain impulse when other methods of anesthesia are ineffective.

Antispasmodics

Pharmacological group	Main Representatives	Dosage and method of application, special instructions
Myotropic antispasmodics	Drotaverine Papaverine	Intramuscularly, 1 - 2 ml until colic is removed.
m-cholinolytics	Hyoscine butyl bromide	Inside or rectally, 10-20 mg 3 times a day
m-cholinolytics	Atropine	Intramuscularly at 0.25 - 1 mg 2 times a day

Antiemetics

Drugs that reduce urine production

The most rational is the relief of renal colic with intramuscular injection ketorolac in combination with metoclopramide and any myotropic antispasmodic. If ineffective, you can resort to narcotic painkillers, which must be combined with atropine. The purpose of other drugs depends on the specific clinical situation. The duration of treatment depends on the duration of renal colic, and can be 1 to 3 days ( in some cases more).

In addition to the listed drugs, drugs from the group of blockers can be used. calcium channels (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 concentration can be used. uric acid, diuretics.

Surgery

Surgical treatment allows you to quickly and completely eliminate the obstruction that caused blockage of the urinary tract. This method of treatment is used in cases where conservative drug therapy is not effective enough, or when any complications have developed.

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.

Since the main cause of renal colic is urolithiasis, in most cases there is a need for surgical removal of stones from the urinary tract. To date, several effective methods, which allow you to break and extract stones with the least injury.

Stones can be removed in the following ways:

remote lithotripsy;
contact lithotripsy;
percutaneous nephrolithotomy;
endoscopic stone removal;
stenting of the ureter;
open kidney surgery.

Remote lithotripsy
Remote lithotripsy is a modern method of stone destruction using a focused high-energy ultrasound beam, which, upon impact on the stone, causes it to crush. This method is called remote due to the fact that it can be used without breaking the skin, by applying the device to the skin in the corresponding region ( For best results and muscle relaxation, this procedure is performed under general anesthesia.).

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.

contact lithotripsy
Contact lithotripsy involves direct exposure to high-energy physical factor (ultrasound, compressed air, laser) on a stone ( this is achieved by inserting a special tube through the urinary canal into the ureter or by puncturing the skin at the level of the stone). This method allows you to more accurately and efficiently affect the stones, and also provides a parallel extraction of the destroyed fragments.

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 removal stones
Endoscopic stone removal involves the introduction of a special flexible or rigid instrument equipped with 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 this moment practically not used. 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.

Preparing for surgical removal 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.

The recovery time after surgery depends on the extent of the operation. For non-invasive and minimally invasive procedures ( lithotripsy, endoscopic and percutaneous stone removal) return to normal activity is possible after 2 - 3 days.

Treatment with folk remedies

Alternative methods of treating renal colic should be resorted to only when it is not possible to obtain qualified medical care.

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 fruits 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.

Some medicinal plants can be used for the treatment and prevention of urolithiasis, as they help dissolve and slow down the growth of stones. It is extremely important to select medicinal plants based on the chemical composition of cameos, since the use of an incorrect remedy can cause an aggravation of the disease.

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

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

Urates ( uric acid) stones
For the treatment of urate stones, decoctions from mixtures of several plants are used, which are taken within 1.5 - 2 months.

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.

Oxalate and phosphate stones
Treatment of oxalate and phosphate stones is carried out over several courses, each of which lasts 2 months, with a break between them of 2 to 3 weeks.

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?

For the prevention of renal colic, it is necessary:

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?

With renal colic and urolithiasis, it is necessary to avoid factors that contribute to the growth of stones and spasm of the ureters. To this end, it is recommended to follow a diet with a reduced content of stone-forming substances.

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.

Must be avoided:

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

Kidney disease among women is now becoming more widespread. Anatomical features urinary diversion systems, the process of pregnancy affect the incidence of these pathologies. Many of them proceed hidden with a minimum set of signs of trouble. They are often discovered by chance during a routine examination. However, there are problems in the urinary system, which from the first seconds make you seek help from a specialist. These situations include renal colic.

Features of the formation and excretion of urine

To bring out all the waste and toxic substances in the human body, not one organ is provided, but a whole system of several interconnected structures. It is dominated by special paired organs located in the lumbar region - the kidneys. It is here that the path of all metabolic products to be removed from the body begins. All blood many times a day passes through a special filter located in the vascular glomeruli. Here, the liquid part of the blood, devoid of its cells, under pressure pumped by the heart muscle, passes from the vascular bed into the structures of the glomerulus.

Nephron - the main structural element of the kidney

However, in this filtrate there are quite a lot of useful substances that the kidneys will return to the bloodstream. This process of separation into useful and harmful occurs in special tubes - the renal tubules. Their final sections are collected in several cups, from which the urine of the composition enters the pelvis. It is a cavity that serves to temporarily accumulate urine, which subsequently enters a long tube - the ureter. It connects the renal pelvis with bladder, from where urine, after temporary storage, is discharged in portions through the urethra (urethra).

The kidney is the main organ of the urinary system

All blood from which is subsequently filtered harmful substances delivered to the kidney via the renal artery system. In the region of the cups there are special vascular venous plexuses - fornixes. The purified blood is carried along the renal vein towards the heart.

Renal colic - sudden attack intense pain in the lumbar region, which arose against the background of a violation of the outflow of urine from the kidney. It often occurs in women, including during pregnancy. This situation requires medical intervention, since a protracted attack can destroy a healthy kidney.

Types of renal colic

Renal colic is divided into several varieties:

Causes of the onset and recurrence of renal colic

Renal colic is recognized as one of the most intense pain that a person can experience with various diseases. In this regard, it can only be compared with heart attack. The mechanism of pain in renal colic consists of several points:

Renal colic - video

Kidney stones as a cause of renal colic

The most common cause of blockage of the outflow of urine from the kidney are stones (calculi). Urolithiasis causes more than half (57%) of all cases of renal colic. In many situations, stones exist inside the kidney for a long time without causing any sensations. But as soon as they begin to move from the pelvis down the ureter, in a large percentage of cases, its lumen is completely closed. For the occurrence of renal colic, the stone does not have to have a record size at all. The situation is aggravated by the muscles of the ureter, which tightly cover the stone and try to direct it towards the bladder. In addition, calculi have sharp edges and can injure the inner lining of the ureter.

Coral stone - record holder among kidney calculi

There are four main types of stones by chemical composition - urate (from uric acid), phosphate, oxalate (from oxalic acid) and cystine (from the amino acid cystine). In many cases of urolithiasis, there is hereditary predisposition or there is a series specific diseases associated with changes in the composition of urine - gout, dysmetabolic nephropathy. In the first case, the excretion of uric acid from the body is impaired. In the second, stones are formed from urine, the composition of which is significantly changed by a large amount of salts (urates, phosphates, oxalates).

Urolithiasis - video

Pyelonephritis and other causes of renal colic

In more rare cases, blockade of the outflow of urine occurs due to inflammation of the cups and pelvis of the kidney - pyelonephritis. The immediate obstacle in this situation is the accumulation of mucus and pus - leukocytes killed in the fight against infection of white blood cells. An attack of renal colic often occurs with an abnormal structure or location of the kidney - prolapse of the organ, narrowing of the ureter. The presence of a kidney tumor always creates a risk of its spread to the ureter, pelvis, vessels and neighboring organs. In this situation, an attack of renal colic may also occur.

A blood clot can block the flow of urine from the kidney. The source of blood for it can be vessels destroyed by a stone, inflammation or tumor. Blockage of the kidney vessels themselves can cause part of the kidney to die due to lack of blood circulation (kidney infarction). Injury to the kidney (bruise or wound) can lead to the formation of massive blood clots.

Pyelonephritis - video

Picture of an attack of renal colic in women

Renal colic is not just an attack of pain. It comes with many important features:

After the disappearance of the pain attack, there is a high risk of a recurrence of an episode of renal colic (80%).

Diagnostic methods

Recognition of the fact of renal colic, as a rule, does not cause any special difficulties for a urologist. The typical nature of pain, the circumstances preceding the attack, the inability to alleviate negative sensations by changing the position of the body are the main points that the doctor relies on when diagnosing renal colic itself. Finding out the cause of the episode is a more complex and lengthy process, based on analyzes and instrumental studies:

in the general blood test big number white leukocyte cells and a high ESR (erythrocyte sedimentation rate) indicate the presence of inflammation in the body;
biochemical analysis blood gives the doctor information about the ability of the kidneys to filter waste and toxins. The most important in this regard is the level of two chemicals - urea and creatinine. Values that go beyond the limits of the norm indicate that the kidneys are not doing their job;
Urinalysis is mandatory for any kidney disease. In this case, the composition and other indicators reflect the state of the organs and the processes occurring in them. Erythrocytes found in the urine sediment under a microscope indicate damage to the renal filter or any of the vessels. Leukocytes, which are normally found in a single amount, allow us to conclude that bacteria have penetrated the kidney and the formation of an inflammatory focus. Salt crystals, visible under a microscope when examining urine sediment, allow us to conclude that the composition of urine has changed and the tendency to form calculi;
Salts - the basis for the formation of stones
specific urine tests (according to the method of Nechiporenko, Amburge, Addis-Kakovsky) allow you to more accurately determine the intensity with which red and white blood cells come out;
The Zimnitsky test is used to determine the ability of the kidneys to filter blood and is based on measuring the density of urine and its volume released at different times of the day. Low density, reduced volume of urine, the predominance of its excretion at night are unfavorable signs indicating the presence kidney failure;
sowing urine on a special nutrient medium allows you to establish the type of bacteria that caused inflammation in the kidney, as well as determine which of the antibiotics will effectively affect them;
Bacteria can be grown on a nutrient medium
ultrasound is a painless method that allows you to see the structure of the kidney and pelvis. The study helps to identify the presence of stones, tumors, inflammatory foci, structural abnormalities;
excretory urography provides information about the structure and function of the kidney. Prior to the study, a special radiopaque preparation is injected into the vein. A few minutes later, with the blood flow, the chemical reaches the renal glomeruli, pelvis and tubules. The method is used to detect abnormalities in the structure of the kidney, pelvis, ureter, and also allows you to judge the ability of organs to filter blood;
Excretory urography is performed using a radiopaque preparation
tomography (computer, magnetic resonance) currently allows you to build a three-dimensional model of the kidney, its vessels and ureters. A radiopaque preparation is also used for this purpose;
Tomography - a method for a detailed study of the anatomy of the kidneys
cystoscopy is performed using a special thin tool entered in bladder through the urethra. The method allows you to see stones, blood clots, as well as to observe the separation of urine from the ureters in real time.

Renal colic in women must be distinguished from other serious diseases:

Pregnant women suffering from urolithiasis often experience attacks of renal colic. They must be distinguished from the onset of labor activity (contractions). However, the attack itself can cause premature onset of labor.

Ectopic pregnancy - video

Methods for the treatment of renal colic

The treatment of renal colic in women is handled by a specialist urologist. There are three levels of therapy:

pain relief with medication;
elimination of colic with the help of surgical intervention;
treating the illness that caused the episode.

Conservative treatment

To relieve an attack of renal colic, thermal procedures are primarily used. A warm heating pad or a sitz bath with a temperature of no more than 37-39 ° C (in the absence of fever) helps to relax the muscles of the ureter, the passage of stones and blood clots. To enhance the effect, medicines are used:

painkillers - Analgin, Baralgin, Ketorol;
drugs that relax the muscles of the ureter - Atropine, No-shpa, Drotaverine, Platifillin, Papaverine;
local anesthetic drugs - Novocaine, Ultracaine. They are injected directly into the painful focus in the lumbar region (novocaine blockade).

In the treatment of colic in pregnant women, thermal procedures are contraindicated. From medications preferably the use of Analgin, No-shpy, Papaverine.

In some cases, it is necessary to treat renal colic under the supervision of a specialist in a specialized department of a hospital. The indications for this are:

pregnancy;
renal colic in the presence of a single kidney;
elderly age;
suspicion of blockade of the outflow of urine from both kidneys;
high body temperature;
inefficiency of conservative methods.

To relieve renal colic, physiotherapy is effectively used:

acupuncture - a point effect on the active points of the body;
diadynamic therapy uses the beneficial effect of pulsed electric current;
ultrasound therapy helps to relieve inflammation and swelling;
vibration massage normalizes blood flow and lymph flow in the kidney and surrounding tissues.

Treatment of renal colic folk remedies not carried out.

Preparations for the treatment of renal colic - photo gallery

Ketorol effectively relieves pain No-shpa is used to eliminate spasms Platifillin effectively relieves spasm
Papaverine relaxes the muscles of the ureter Novocaine is used to block certain areas of the body Baralgin is used to relieve pain in renal colic

Surgery

Surgical intervention for renal colic pursues the main goal - to resume the outflow of urine from the kidney, thereby normalizing the pressure inside the pelvis. To accomplish this task, there are two methods: nephrostomy and stenting of the ureter. Nephrostomy involves the creation of an artificial way for the outflow of urine, bypassing the blocked area. Under local anesthesia, a special design is installed into the pelvis through a puncture in the lumbar region - a nephrostomy, which will collect urine into a receiver. Unloading the kidney will relieve the pain attack and give time to identify the cause. Ureteral stenting involves the introduction of a special design that is fixed in place and helps to establish the outflow of urine from the kidney.

The stent allows urine to flow out of the kidney

Diet

Diet correction is a mandatory measure after the removal of an attack of renal colic, since there is a high risk of its recurrence. However, the choice of the right foods is primarily determined by the composition of urine and stones.

Diet for urolithiasis - table

Products approved for consumption	Foods to be restricted	Products not recommended for consumption
oxaluria
Brussels sprouts, white cabbage, cauliflower; apricots; bananas; melons; pears; grape; pumpkin; cucumbers; peas; all types of cereals; potato; cabbage; White bread; vegetable oil.	carrot; green bean; chicory; tomatoes; strong infusion of tea; milk and dairy products; beef; chicken; aspic; liver; cod; currant, Antonov apples; radish.	cocoa; chocolate; beet; celery; spinach; sorrel; rhubarb; parsley leaf; broths.
Uraturia
dairy products in the first half of the day; potato; cauliflower and white cabbage; cereals (buckwheat, oatmeal, millet); fruits; dried apricots; prunes; seaweed; wheat bran; wheat bread, rye bread from wholemeal flour; lean meat and fish 3 times a week, 150 g for older children in boiled form; decoction of oats, barley.	peas; beans; beef; chicken; rabbit.	strong tea; cocoa; coffee; chocolate; sardines; animal liver; lentils; pork; offal, oily fish; meat and fish broths.
Phosphaturia
butter, vegetable; semolina; pasta; flour of the highest and 1st grade; potato; cabbage; carrot; cucumbers; beet; tomatoes; apricots; watermelon; pears; plum; strawberry; cherry.	beef; pork; boiled sausage; egg; corn grits; flour of the 2nd grade; milk; sour cream; slightly alkaline mineral waters.	cheese, cottage cheese; beef liver; chicken meat; fish, caviar; beans, peas; chocolate; cereals: oatmeal, barley, buckwheat, millet; alkaline mineral waters.
cystinuria
enhanced drinking regime; slightly alkaline mineral waters; potato; cabbage; meat and fish in the morning.	-	cottage cheese; fish; eggs; mushrooms.

Useful and harmful foods for kidney stones - photo gallery

A diet with oxaluria allows you to eat first and second courses of cabbage With oxaluria, chocolate is excluded With uraturia, you should limit the use of peas With urates, you can eat dairy in the morning With phosphates, it is advisable to exclude fermented milk products from your diet
With phosphates in the urine in vegetables and greens, you can not limit yourself. In cystinuria, foods rich in methionine and sulfur-containing amino acids are prohibited, for example, cottage cheese, eggs

Complications and prognosis

The prognosis for the treatment of renal colic is usually favorable. However, a prolonged attack, in which assistance was not provided on time, can lead to negative consequences:

Prevention

To prevent the development of renal colic, a number of recommendations must be observed:

conducting an annual medical examination with a urine test;
adherence to a diet with identified changes in the composition of urine;
timely treatment of inflammatory diseases of the kidneys and urolithiasis.

Renal colic is a serious situation. An intense pain attack in the lumbar region is a reason to contact a specialist for emergency assistance. However, it must be remembered that the removal of painful sensations is only the first stage. Subsequently, it is required to find out the cause and treat the underlying disease.

Renal colic is a cramping pain caused by spasm of smooth muscles due to problems with urine output. Basically, the symptom develops as a result of blockage of the ureters with stones. ICD code 10–23.

Causes of colic

In about 90% of cases, it becomes a provocateur of renal colic. Until now, medicine does not know exactly why sand and stones form in paired organs. The lesion can be found both on the right and on the left. 15–30% are diagnosed with bilateral urolithiasis.

Main Factors

Manifestations of renal colic are often associated with injury or disease, leading to narrowing or compression of the lumen of the ureter. At the same time, the blockage of the passage has a different localization - the excretory canal itself, the bladder, the renal pelvis.

The provocateurs of renal colic include:

Cause	Pathogenesis
Urolithiasis disease	The most common factor The exit of the calculus from the renal pelvis is able to block the ureter.
Pyelonephritis	Infectious process caused by streptococci, staphylococci, influenza, Escherichia coli. It is caused by desquamation of the epithelium, the appearance of purulent foci, which become an obstacle to the progress of urine.
injury	It is characterized by hematomas and blood clots that compress the canal.
Structural features	The risk of renal colic increases with anatomically incorrect development of the organ - dystonia, nephroptosis, abnormal attachment of the ureter to the bladder. Rarely lead to pathology, a person may not be aware of the presence of such problems. Violation of the outflow is provoked by mechanical damage, infections. In this case, the attack develops unexpectedly for the patient.
Oncology	The growth of a benign or malignant nature compresses the ureter or pelvis of the organ. But only with a local neoplasm of the kidney, excretory canal, or in case of tumor germination in close proximity to them.
Tuberculosis	In about 30% of patients with this disease, pathogens are present outside lung tissue. Often pathogens penetrate into the kidney.
kink of the ureter	Along with the impossibility of outflow of urine, there is an increase in pressure in the pelvis. Appears due to mechanical damage, congenital structural anomaly, changes in the position of organs, oncology, overgrowth fibrous tissue in the retroperitoneal area.
Additional vessel	The presence of an "extra" bloodstream in the vicinity of the ureter can lead to a gradual narrowing of the canal.
Allergic reaction	An extremely rare symptom. Puffiness of the ureter develops due to the use of certain drugs - iodine, Codeine. It is accompanied by vasodilation, penetration of plasma beyond their walls, which is the cause of a negative clinic.
blood clots	Getting into the lumen of the excretory path, cause blockage. A large clot is formed due to trauma, growth of tumors, ICD, which provoke the destruction of mucous tissues and, as a result, bleeding.
paranephritis	It is characterized by damage to the parenchyma of the kidney, in the future, the process affects the perirenal tissue. A large amount of pus is produced, which fills the urinary tract, causing colic.
Cystitis	Inflammation of the bladder is often caused by an infection that can travel up to the ureter.
Vesicoureteral reflex	There is a reflux of urine from the bladder into the lumen of the canal. It provokes an increase in pressure in the pelvis of paired organs, fluid stagnation, which becomes a provocateur of the formation of stones.
Gout	Metabolic disorders, including uric acid. Its accumulation increases the risk of formation of urate compounds.
Cholelithiasis	The presence of stones in the gallbladder increases the likelihood of KSD by 26-32%.
Immobilization	Prolonged immobilization negatively affects all systems. The kidneys are also endangered, as the level of calcium and phosphates, vitamin D, necessary for normal metabolism, decreases.

These are far from all provocateurs of the renal clique. A characteristic clinical picture develops due to the intake of sulfa drugs, excessive use ascorbic acid, problems with the gastrointestinal tract, Paget's and Crohn's diseases. Even barometric fluctuations during a voyage by plane can cause an attack.

Related factors

The risks of developing renal colic are divided into 2 types:

are common;
private.

The first group includes:

Floor. More often, pathology is diagnosed among men.
Number of years. People in the 30-50 age group are more susceptible. In children, boys and girls, the elderly, the problem occurs much less frequently.

To the second:

Heredity.
Profession. Often, pathology is diagnosed in workers of hot shops.
Climatic conditions. Greater danger people living in the northern and southern regions are susceptible.
Active physical activity. Sometimes ICD is detected in athletes.
Lack of liquid in the diet, composition of water in the region.
Frequent consumption of animal proteins, salty foods, smoked meats, chocolate.
Limited level of vitamin A. Causes desquamation of epithelial cells, which become the nuclei of crystals.
Lack or excess of vitamin D. This substance affects the ability of calcium to bind oxalic acid in the intestines, which, accumulating, settles in the kidneys and leads to the formation of oxalates. The body needs 600 IU of the vitamin per day.
Dehydration. It is noted both against the background of a small supply of moisture, which leads to an increase in the density of urine, and as a result of intensive evaporation through the surface of the skin.

Important! In 55% of patients, attacks of renal colic are included in the family history.

Signs of renal colic in men and women

Symptoms of renal colic appear suddenly in a seemingly healthy person. They are not preceded by special physical activity, the picture is almost independent of external factors.

Symptom	Description
Pain	Unbearable, cramping, painful, sharp, stabbing. Dangerous, capable of causing convulsions and shock. It is impossible to take a position in which painful sensations are weakened, it is difficult to take a breath. It can irradiate to the side, lower back, anterior femoral surface, rectum, groin, genitals and abdomen - this is due to the localization of the affected area of the ureter or kidney. Unlike hepatic colic, it is constant.
Hematuria	Blood in the urine may be visible to the naked eye or detected by a laboratory examination of a sample.
Dysuria	Difficulties with the withdrawal of urine are possible. It is characterized by false urges, a small volume of fluid. The process is painful. With complete bilateral obstruction, the outflow of urine stops. If one kidney is affected, the second actively accumulates and passes fluid through itself, so the pathology is not accompanied by a lack of urine.
Vomit	It is provoked by severe pain, leading to autonomic disorders - sweating, general weakness and nausea. Also, the reason is the insufficient functioning of nerve endings directly at the site of pain, which causes problems in the gastrointestinal tract. Symptoms of this type are not associated with food, drink. It is not possible to eliminate vomiting with the help of sorbents.
Increased flatulence	Develops on the background of disorders of intestinal motility.
Hypertension	During the period of renal colic, blood filtration by paired organs decreases, therefore, there is a slight increase blood pressure. Also, blood pressure rises as a result of the reaction of the brain to painful sensations.
Change in heart rate	Both a decrease and an increase in heart rate are likely.
Chills	Present subfebrile temperature, 37–37.5 ̊С.

The duration of signs of renal colic depends on the speed of the stone, it can be measured in minutes and days.

Important! If the clinical picture is observed for more than 5 days, the consequences are irreversible changes in the organs.

After elimination of an attack of renal coli, the malaise quickly disappears. Urine is excreted in a large volume, since during this time there was an accumulation of fluid in the affected kidney.

During pregnancy

The development of renal colic in a pregnant woman in the later stages is often perceived as the onset of childbirth. And the risk of pathology is quite high - during pregnancy, urolithiasis is diagnosed in 0.2–0.8% of patients. At the same time, the conception and development of the baby does not affect the likelihood of the formation of calculi in any way. Most likely, even before this moment, the process of stone formation began, but the pathology proceeded latently, without a pronounced clinical picture.

Most often, symptoms appear in the third trimester:

cramping pain;
the presence of blood in the urine;
stone exit.

The symptoms are really similar to labor activity and usually the diagnosis of ICD is made already in the hospital. I must say, an attack is quite capable of leading to a discharge of water and the premature birth of a baby.

The main problem is to relieve pain. Pregnant women are prohibited from using most medications, as they lead to negative side effects of fetal development. Heating is also contraindicated. Therefore, treatment is carried out, trying to minimize the risks.

Usually prescribed:

Injections of papaverine hydrochloride, 2 ml of a 2% solution, Noshpy, platyfillin hydrotartrate 0.2% subcutaneously.
If the attack started at home, you can take 2 tablets of Avisan or 20 drops of Cystenal on a piece of sugar under the tongue - the drugs stop renal colic and at the same time have an anti-inflammatory effect.

Important! It is advisable to immediately call emergency care, since the risk of labor pains and infection with renal colic increases significantly.

In children

At a younger age, the pathology proceeds atypically, which leads to medical errors. You can identify the problem by carefully observing the behavior of the child.

Often the baby incorrectly points to the navel as a place of localization of pain. But sometimes the symptom really manifests itself throughout the abdomen.
Cries, behaves uneasily, does not allow touching the painful area.
Present liquid stool or constipation.
Bloating of the abdominal cavity due to the accumulation of gases, reflex vomiting are noted.

To make a competent diagnosis, you need to check for back pain, as well as examine muscle tone, especially when it comes to an infant. To do this, they resort to the definition of Pasternatsky's symptom - the fingertips are applied to the kidney area and shake the tissues with them.

But it is worth remembering that this method helps to suggest renal colic, and not make a final diagnosis. A confirmatory result is also obtained in the case of appendicitis with an incorrect location of the process, thrombosis of the vessels of the mesentery, intestinal obstruction. Therefore, a thorough examination in a hospital setting is necessary.

Emergency care stops an attack only if there is no doubt. Parents before her arrival can independently reduce pain symptom by placing the child in a bath with a water temperature of 37–39 ̊С. If this measure did not work, apply Noshpa or Baralgin. But it is desirable to know exactly the allowable dosage.

With renal colic, the child is hospitalized. Surgical treatment is not excluded.

Important! The formation of stones in babies is usually triggered by a hereditary factor and illiterate nutrition. If the baby is on breastfeeding, mom should be careful about her own diet.

Complications

If treated in a timely manner, complications do not develop. With delayed therapy or, for example, the use of medications, the use of folk remedies without the consent of the doctor, an unfavorable outcome, even death, is possible.

An acute attack of renal colic is dangerous, as it provokes:

Obstructive pyelonephritis is one or two-sided inflammation of paired organs, accompanied by suppuration.
The appearance of strictures in the walls of the ureter, which leads to a persistent narrowing of the lumen.
Urosepsis - toxic injury tissues of the urinary system.
Nephrosclerosis or kidney atrophy.

In order not to complicate the process, at the slightest sign of renal colic, you should contact a urologist or call an ambulance.

Diagnostics

To clarify the clinical picture, the patient must describe in detail to the doctor the symptoms present. In addition, it is important to clarify the place of work, diet, the likelihood of an allergic reaction. It is advisable for women and girls to remember when the last menstruation was - this will help to exclude an ectopic pregnancy.

Apply both laboratory and hardware methods.

Clinical diagnostics involves analysis of urine samples to detect changes in composition. For research, a portion of morning urine and daily urine is provided. In the first case, the presence of impurities is determined, in the second, the functionality of the kidneys is assessed.
The liquid may contain leukocytes, erythrocytes or their destroyed fragments, pus.
The concentration of salts increases - oxalates, calcium, cysteine, urates.
Check the reaction to acids and alkalis.
During the infectious process, pathogenic bacteria are detected.
Increasing creatinine.

Important! If a stone comes out, it is advisable to transfer it to laboratory assistants. The composition of the calculus influences the scheme of further therapy.

Hardware diagnostics:

Ultrasound - penetrating into the body, ultrasonic waves are reflected from dense areas, allowing you to see the features of the structure of the kidneys, bladder and the channel connecting them, stones.
Radiography - helps to identify oxalates and calcium deposits.
Excretory urography - the introduction of a contrast solution to determine the condition of the blood vessels, as well as the ureter. Thanks to this, it is possible to visually assess the degree of narrowing of the passage, the ability of the kidneys to maintain the required level of filtration and fluid concentration. It is used after stopping an attack, when blood circulation and urine outflow are restored.
CT is recommended to determine the density of stones and the degree of damage to the ureter.

The program of procedures largely depends on the alleged cause of the pathology, and can be significantly expanded. But first of all, x-rays are usually taken, since in most cases a patient with renal colic has calcium stones and oxalates. Computed tomography is not cheap, therefore it is used when other methods are insufficiently informative.

Differential Diagnosis

recommended to clarify the diagnosis. In renal colic, there are no signs characteristic only for this disease. A similar clinical picture develops in many pathologies of the gastrointestinal tract, genitourinary system. With the help of laboratory tests of the provided blood and urine samples, problems with such symptoms are ruled out.

Treatment tactics for men and women

The main task for renal colic is to relieve severe pain, normalize the withdrawal of fluid, as well as find out the cause of the ailment and conduct its therapy. At the last stage, attract narrow specialists.

First aid

The patient can independently try to anesthetize the exit of the stone before the arrival of the ambulance.

Algorithm of pre-medical therapy:

With each spasm, inhale deeply, remain calm.
Take an antispasmodic or analgesic - an adult is allowed to swallow 2 tablets of Drotaverine or Noshpa 80 mg each or 4 tablets 40 mg each. If possible, it is better to inject intramuscular solutions. The herbal preparation Urolesan in capsules, in the form of syrup or drops will help.
In the absence of these funds, Nitroglycerin placed under the tongue is suitable.
With left-sided colic, Baralgin, Paracetamol, Citramon, Ketanov, Revalgin are taken. If the pain manifested itself on the right, which is characteristic of appendicitis, such drugs are prohibited, since pain relief will lubricate the symptoms and make diagnosis difficult.
If you are sure that the discomfort is caused by the advancement of the calculus, you can apply a heating pad to the painful area or take a hot bath.

Important! Thermal procedures are strictly prohibited with a clinical picture of an unknown nature to the patient, as they can lead to a deterioration in the condition.

As a rule, patients with renal colic are recommended therapy in a hospital. Vital indications include:

Severe complications - blood pressure below 100/70 mm. rt. st, temperature exceeding 38 ̊С.
Bilateral pain.
Having only one paired organ.
Elderly age.
The lack of a positive effect in the provision of first aid.

In these cases, hospitalization is necessary, as doctors will restore urinary function, which will help to avoid irreversible changes in the structure of the kidneys, to prevent a tragic outcome.

Also, patients with an unexplained nature of renal colic are sent to the hospital.

Urgent Care

The arriving doctor or paramedic makes a preliminary diagnosis, on the basis of which he administers an analgesic or antispasmodic, taking into account possible contraindications. The drugs of choice include:

Baralgin M - incompatible with alcohol and Analgin.
Ketorolac is prohibited for children under 16 years of age, with asthma, acute ulcers, severe renal failure.
Noshpa - can not be used in renal failure and hypersensitivity. Use with caution in atherosclerosis of the coronary arteries, open-angle glaucoma, prostatic hyperplasia.

After emergency care, the patient is offered hospitalization. With consent, they are transported to the inpatient department on a stretcher.

If the stone has passed by the time the medical team arrives, the person often refuses to go to the hospital. But in the first 1–3 days, medical supervision for condition and quality nursing care. It is possible that more than one calculus has undergone movement and in the future an attack of renal colic will be repeated.

Medical therapy in the hospital

With renal colic, treatment is carried out in a complex manner. Prescribe medications to relieve symptoms:

Group	Action	Dosage
Painkillers	Eliminate pain	Ketorolac intramuscularly 3-4 times a day, 60 mg for no longer than 5 days. Diclofenac IM 75-100 mg with further transfer to tablets. Paracetamol 500-1000 mg. Baralgin 5 ml 3-4 times a day IM or IV. Codeine 1% in combination with Atropine 1%, 1 ml of each solution. Lidocaine or Novocaine for local blockade of nerve endings if other methods fail.
Antispasmodics	Remove spasms of smooth muscles of the ureter	Drotaverin i / m 1-2 ml until the symptoms disappear. Atropine 0.25–1 ml IM. Hyoscine butylbromide three times a day orally or rectally, 10-20 mg.
Decreased urine production	Reduce pressure in the renal pelvis	Desmopressin - IV 4 mcg or nasal spray 10-40 mcg.
Antiemetics	block the reflex	Metoclopramide IM 10 mg 3 times a day, later in the form of tablets.
Alkalinizing urine	Dissolves uric acid stones	Sodium bicarbonate in an individual dosage, which is determined by the reaction of urine.

When a bacterial infection joins, pus is present, antibiotics are introduced into the therapy program.

The average course is 1-3 days.

Surgery

The operation is performed if conservative methods fail to eliminate the blockage of the ureter, severe consequences of the underlying pathology have developed.

Indications:

complicated urolithiasis;
the size of the stones is more than 1 cm;
no effect after therapy.

Modern methods provide sparing surgical intervention with minimal risk of injury.

Contact lithotripsy - the impact of compressed air, ultrasound, laser beam on salt deposits. It is accompanied by a puncture of the skin or the tube of the apparatus moves through the urethra to the ureter.
Remote lithotripsy - ultrasound is used to destroy stones larger than 2 cm in diameter, localized in the upper or middle part of the pelvis. It is performed without damaging the skin, but under general anesthesia for high-quality relaxation of muscle tissue. Contraindications: pregnancy, blockage of the ureter, densely packed stones, bleeding disorders.
Endoscopy - a flexible instrument is inserted into the ureter through the urethra to capture and remove the calculus.
Stenting - a metal frame is installed in the narrowed lumen, which allows you to expand the passage and prevent further renal colic.
Percutaneous nephrolithotomy - stones are removed through a puncture. The procedure is controlled by an x-ray machine.

Open-cavitary kidney surgery is rarely used, as it is the most traumatic. It is indicated for purulent-necrotic process, damage to the tissues of the organ, in the presence of especially large calculi.

If the surgical intervention was carried out using a sparing method, the patient can leave the inpatient department after 2-3 days.

Renal colic and acute intestinal obstruction

Often, against the background of renal colic, intestinal volvulus develops. It is accompanied by severe pain, but the person's condition is considered satisfactory.

Symptoms include nausea with no relief and repeated vomiting, which leads to the diagnosis of intestinal obstruction. With renal colic, a single attack is more often noted.

For the examination, listening to the abdominal area is used - intense noises in the intestinal region are characteristic. Urinalysis reveals hematuria.

Diet

Meat and fish are consumed only in boiled form.

Shown to exclude from the menu:

salt;
sweet pastries;
fresh bread;
broths;
smoked meats and sausages;
fatty cheeses;
fried and boiled eggs;
salinity;
marinades;
canned food;
radishes, mushrooms, spinach, legumes, sorrel, radishes, onions and garlic;
spicy seasonings;
chocolate and coffee;
fatty meats, liver, duck, brains, kidneys;
fruits with coarse fiber.

After diagnosis, the diet is adjusted with the help of a nutritionist who will take into account the cause and develop an optimal nutrition program.

For example, with urolithiasis, it is shown to introduce more products with dietary fiber preventing the formation of stones. To do this, it is enough to use daily:

100 g of bread from coarse flour;
200 g potatoes;
70 g carrots;
30 g of beets;
100 g pears.

But at the same time, it is necessary to know exactly the composition of the stones. Otherwise, an incorrectly selected diet can worsen the patient's condition.

With urate compounds, they consume more dairy products, juices, fruits and vegetables, reduce the volume of meat, fish, legumes, cereals, eggs.
In the presence of oxalates, bread made from wholemeal flour, rye and wheat bran, millet, pearl barley, oatmeal and buckwheat, dried fruits are introduced into the diet.
If phosphaturia is detected, the diet is diversified with bakery products, poultry, fish, meat, cereals without milk, pumpkin, honey and weak coffee or tea, compotes, confectionery sweets.

The differences in the menu are huge and you can’t do without the help of a specialist.

Effective folk methods

If it is not possible to resort to medicine, renal colic therapy is performed at home. There are several recipes to reduce pain.

Hot bath with the addition of sage or birch leaves, cudweed, linden flowers or chamomile. For one session, 10 g of vegetable raw materials are enough.
Infusion of steel roots, mint and birch leaves, juniper berries. Mix the components in equal volumes and brew 1 liter of boiling water 1 tbsp. l. collection. After half an hour, the folk remedy is filtered and drunk.
To soften the withdrawal of oxalates and phosphorus calculi, inflorescences of immortelle, blue cornflower and black elderberry, budra grass, burnet roots and bearberry leaves are used. A glass of boiling water pour 2 tbsp. l. funds and insist 15 minutes on a steam bath. Pass the solution through a sieve after 4 hours. In a warm form, they drink 4 times a day after meals, 50 ml.
A good therapeutic effect is provided against urate stones by barberry fruits in combination with juniper, harrow root and shepherd's purse. Steamed in a liter of boiling water 2 tbsp. l. mixture and continue heating for 15 minutes. After removing from the stove, stand for 4 hours in a closed container. Take 50 liters four times a day before meals.

Folk recipes help not to get sick, if you first consult with a urologist about the possibility of their use. It is necessary to take into account the characteristics of salt deposits, the risk of an allergic reaction to the ingredients, and discuss the duration of the course. Otherwise, home therapy will not bring benefits.

Forecast and prevention

If you seek medical help in a timely manner, the prognosis of renal colic is favorable. When the diagnosis and visits to the doctor are delayed, the disease becomes more complicated, which increases the likelihood of death as a result of shock, sepsis, and organ failure.

You can prevent the development of renal colic by following simple recommendations:

The predisposition should be the basis for regular examinations and consultations with a urologist.
It is necessary to consume enough vitamins A and D. If it is not possible to replenish their reserves with natural products, use special complexes.
Sunbathing helps the body produce vitamin D on its own.
Do not neglect moderate physical activity.
Food must contain calcium.
Drink at least 2 liters of fluid daily.
Metabolic problems should be corrected, diseases of the urinary system should be treated.
Be sure to follow the principles diet food to reduce the likelihood of renal colic - exclude from the menu products that contribute to the formation of stones.
Do not expose the body to hypothermia.
Avoid injury in the lumbar region.

Prevention is constantly adhered to, if necessary, changing the usual lifestyle and diet.

Questions from readers

Naturally, a person with a predisposition to renal colic is concerned about the features of the process itself and therapy. Here is information to help you get answers.

How are vomiting and renal colic related?

The reason must be sought in the placement of nerve fibers. Both the kidneys and the gastrointestinal tract receive signals from the same zone. When the progress of the stone leads to a problem with the outflow of urine, the solar plexus is simultaneously irritated. This becomes a provocateur of attacks of nausea and vomiting, flatulence, difficulty with the discharge of feces.

Why does my bladder always seem to be full?

Such a feeling with a small release of urine is explained by the structure of the nervous system. When the stone descends into the lower part of the ureter, the receptors are irritated, causing the desire to empty. The symptom is both positive and negative at the same time. In the first case, it is noted that the calculus has passed the longest segment and will soon enter the bladder. However, the connection of the organs is narrow and a stone of considerable size easily gets stuck in it.

Can something provoke the onset of renal colic?

As a rule, an attack of renal colic begins suddenly. Sometimes it is preceded by a long trip by car, train, flight. Perhaps the occurrence of a clinical picture against the background of taking herbal remedies designed to destroy salt deposits, they become provocateurs of the movement of stones. Also, the cause is a back injury, prolonged abstinence from drinking liquids, after which the patient prefers to drink abundantly.

Is it possible to confuse renal colic with some other disease?

Other pathologies have similar symptoms, for example:

intestinal colitis;
radiculitis;
renal infarction;
acute pleurisy;
appendicitis;
torsion of an ovarian cyst;
ectopic pregnancy.

Therefore, self-treatment is strictly prohibited. A thorough examination is necessary to identify the cause of the pain. It helps to accurately establish the type of disease differential diagnosis.

Can a stone get into the bladder and not come out?

This situation is quite likely when it comes to stones of significant size, exceeding the diameter of the ureter, or the disease is complicated by a narrowing of the lumen, which prevents the release of the stone.

What does a physical examination of a patient show?

What is an ultrasound scan for?

Ultrasound is an affordable, inexpensive and quite informative method in the study of renal colic. Allows you to detect a stone in the ureter, its location, expansion of the renal pelvis. But with obesity and increased flatulence, anomalies of the urinary organs, an ultrasound examination often does not work. Therefore, preference is given to complex hardware diagnostics.

Why do excretory urography and what does it show?

This method for renal colic is recognized as the most informative. It takes place in 3 stages:

First, a picture is taken using an X-ray machine.
The patient is injected with a contrast solution that penetrates the urine.
Re-image.

Thus, a visual representation of the size of the calculus, localization in the renal pelvis or urinary canal is obtained.

There are also contraindications to the procedure. This is an allergic reaction to iodine, which is used to prepare the coloring liquid, and thyrotoxicosis is a pathology. thyroid gland.

What is the essence of lithokinetic therapy?

This technique is based on the use medical preparations, facilitating the exit of large-sized elements. Non-steroidal anti-inflammatory drugs are also used, which relax the muscle tissues lining the canal, as well as antispasmodics that expand the lumen.

How long can a stone pass with lithokinetic therapy?

It takes several days to withdraw. But expectant management in renal colic is interrupted if the calculus does not leave the ureter after 2-3 days. Delay is dangerous due to fibrosis of the clogged area.

What is meant by extracorporeal lithotripsy?

So in urology they call the "gold standard" for the treatment of urolithiasis. The method has been used for 30 years and consists in using a directed flow of mechanical waves that act on salt deposits and destroy them. The procedure is carried out under the control of an X-ray unit or an ultrasound machine. According to statistics, lithotripsy helps to get rid of pathology in 95% of cases.

If the painful sensations have passed, but the stone has not come out, what should be done?

Despite the disappearance of signs of renal colic, therapy is necessary. The calculus remaining in the ureter is dangerous, as it injures the walls of the passage and can move at any time. So, an attack of renal colic will resume.

In addition, blockage of the passage leads to the accumulation of urine in the kidney and to the development of hydronephrosis, damage to the parenchyma of the organ. Therefore, the stone must be removed.

At the first sign of renal colic, you need to call an ambulance. It is not worth treating yourself without knowing the exact cause of the pain, since with an erroneous “diagnosis”, complications are likely to develop that will require prolonged therapy. Therefore, the appeal to official medicine is mandatory.

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.

Causes

The development of colic can provoke various pathologies, however, they are united by one common feature - obturation (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:

Disease	obturation mechanism
Urolithiasis disease	Most often (in 92% of cases) the cause of colic is a stone that clogs the ureter and pelvis. With the development of characteristic symptoms, doctors should first rule out the presence of KSD.
Pyelonephritis	Infection in the kidney most often occurs under the influence of microorganisms: influenza bacillus, streptococcus, staphylococcus, coli. The inflammatory process quite often proceeds with desquamation of the epithelium and fibrin, the formation of pus, which, when passing through the urinary tract, leads to blockage. With an excess of these formations, the lumen of the ureter, which in places of narrowing can reach only 5 mm in diameter, can be clogged. It should also be noted that pyelonephritis quite often develops against the background of the formation of a stone in the kidneys.
	Mechanical damage to the organs of the excretory system can lead to the development of hematomas and compression of the channels by these formations or the formation of blood clots in the lumen of the channels.
Congenital features of organs	This group of causes includes conditions such as abnormal attachment of the ureter to the bladder, incorrect position (dystopia) or prolapse (nephroptosis) of the kidneys. Most often, such features do not cause concern to the patient and quite often go unnoticed throughout life. But under the influence of provoking factors ( infectious process, trauma) may interfere with the outflow of urine and develop an acute condition.
The tumor is benign or malignant	Pathological tissue growth can compress the pelvis or ureter in two cases: if the tumor is located near the structures of the excretory system, or if it grows in these organs.
Tuberculosis of the kidney	According to modern statistical reports, about 30% of patients in TB dispensaries have tuberculosis, which is located outside the lungs. Kidney tissue is one of the places of localization of microorganisms that cause this pathology. Therefore, in the event of colic in a patient with confirmed tuberculosis or the presence of its typical signs(subfebrile temperature, significant weight loss, persistent cough), it is necessary to exclude kidney damage by this pathology.

It is also necessary to single out 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 graduation. 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 area. Optimal effect a warm bath will give (the temperature of the water 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:

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

when pain occurs on both sides;

The patient has only one kidney.

If patients with the 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 has been hospitalized, all necessary diagnostics performed in a 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 allocate:

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 research, including a biochemical blood test and a general analysis of urine and blood. Among instrumental techniques use urography (excretory or intravenous) and ultrasound.

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. To start doing X-ray followed by injection of a contrast agent. 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.

Reading 3 min. Views 1.4k. Published on 25/02/2018

Renal colic is acute attack pain in the lumbar region. When an attack of renal colic begins, a person simply cannot restrain his feelings due to severe pain, which encircle the entire body, forcing them to take a forced position. These spasms can be due to both kidney stones and inflammation of the urinary system.

Why does colic occur in the kidneys

An attack of acute pain in the lumbar region occurs due to a violation of the outflow of urine from the pelvis of the kidney, caused by circulatory problems. The pelvis expands and this contributes to the appearance of unbearable pain.

Colic comes on unexpectedly. Pain in the lumbar region gradually increases, and then spreads to the genital area and legs. It is very difficult to endure this attack, so it is good if there is someone nearby who can provide emergency assistance.

Knowing the cause of the spasm is very important. Can cause renal colic the following diseases:

, as the most common cause. When stones move through the ureters, sharp pain, as well as a stone can completely block the ureter, which will disrupt the outflow of urine;
kidney tumors;
chronic or acute pyelonephritis;
gynecological pathologies;
kidney injury.

Usually an attack does not portend anything, pain sensations come quite unexpectedly. The stone may start to move after a large number drinking liquids (for example, beer or after eating a watermelon), after a fall or a blow to the back. Often in women in position (in the last trimester of pregnancy), a calculus may begin to move away.

colic symptoms

In addition to acute pain in the lower back, colic may be accompanied by:

blood in the urine;
slowing of the pulse;
slight hypertension;
belching, nausea and vomiting;
rarely - fever.

A person who has had renal colic for the first time can easily take it for both stomach and heart pains, because they can radiate to absolutely any organ. To help understand that this is exactly colic, the forced posture of the patient will help, he usually takes a knee-elbow position.

What to do?

If similar condition the first time, you need to call an ambulance. Specialists will deliver the patient to the urological department. There, to relieve pain, an antispasmodic will be administered, more often it is baralgin, if it does not help, then there are stronger painkillers in the hospital.

Then they will conduct an examination and find out the reason, if these are stones and they are small, then they will prescribe a litholytic drug. Stones smaller than 5 mm may come out on their own. If the stones are larger, then crushing them may help, it is carried out remotely, without incisions, directly through the skin. If this does not help, then surgery is required.

For any other pathology, an appropriate treatment will be selected. With inflammation - antibiotics, and if these are tumors or cysts, then most likely also surgery.

Renal colic is a serious condition and you do not need to self-medicate, but you should contact a specialist as soon as possible so that competent treatment is prescribed.