What Is Renal Colic?

Usually refers to sudden pain in the kidney area caused by urinary stones, especially ureteral stones. Acute renal colic is mostly caused by stones, and most of them occur in ureteral stones, so a large part of the so-called renal colic is actually Ureteral angina and renal angina are not an independent disease. They are caused by spasms of the renal pelvis or ureter smooth muscle due to various reasons. There is no sign of their onset, and the pain can even exceed childbirth, fractures, trauma, surgery, etc.

Basic Information

English name

renalcolic

Visiting department

Nephrology

Common locations

Lower back

Common symptoms

pain

Pathogenesis of renal colic

There are two main types:

1. Stones move rapidly or suddenly incarcerated in the renal pelvis and ureter, leading to acute obstruction of the upper urinary tract. Due to the increase in tension of the inner wall of the lumen, the pain receptors in these parts are pulled and cause severe pain;

2. Edema of ureter or calf wall and ischemia of smooth muscle increase inflammatory transmitters, activate more pain receptors, and further increase pain.

Clinical manifestations of renal colic

The typical clinical manifestations of acute renal colic are pain in the waist or upper abdomen, severe intolerance, paroxysmal episodes, and microscopic hematuria, nausea, and vomiting. The patient's rib spine angle tenderness was obvious at the time of examination. Typical colic usually starts at the lower back and upper abdomen at the costal spine corners, occasionally from the lower edge of the ribs, and radiates along the ureter to the ipsilateral groin, inner thigh, male scrotum, or female labia majora. The degree of pain depends on the patient's pain threshold, sensitivity, and the speed and extent of obstruction of the proximal ureter and renal pelvis. Ureteral peristalsis, stone movement, and intermittent obstruction can all increase renal colic. The most obvious pain is often where the obstruction occurs. Stones moving down the ureter only cause intermittent obstruction.

Renal colic manifests itself in three clinical stages:

Acute phase

Typical seizures occur in the morning and at night, and can make patients awake from sleep. When it occurs during the day, the onset of pain has a certain degree of slowness and concealment, often persistent, smooth and gradually worsening. In some patients, pain peaks 30 minutes or more after the onset.

2. Duration

Typical cases typically peak at 1 to 2 hours after onset. Once the pain reaches its peak, the pain tends to persist until treatment or self-remission. The most painful period is called the duration of renal colic. This period lasts 1 to 4 hours, but there are also cases up to 12 hours.

3. Remission period

In the final stage, the pain eases rapidly and the patient feels pain relief.

Renal colic

The necessary imaging examinations include B-ultrasound, plain abdominal film, intravenous urography (IVU), and non-enhanced spiral CT. B-ultrasound has become the screening method of choice for diagnosing renal colic. Its main advantage is that it is not affected by the nature of the stones, whether it is X-ray transparent or opaque stones, and it can also be used to identify some other acute abdomen. For pregnant women with renal colic, ultrasound may be the first choice. An abdominal plain film (KUB) is a cheap, fast, and effective diagnostic method that can accurately understand the size, shape, location, and X-ray permeability of stones. Intravenous urography (IVU) was once the gold standard for the diagnosis of renal colic, but its sensitivity is only 64%, and it is no longer the preferred diagnostic method. Spiral CT can perform continuous scans without leakage, which is very accurate. It is the most reliable imaging method for the diagnosis of upper urinary tract stones. After the onset of colic, spiral CT can often show subrenal effusion, which is a powerful evidence for the diagnosis of acute renal colic.

Diagnosis of renal colic

According to clinical manifestations, the cause of renal colic can generally be determined. For further treatment, the necessary tests are performed to clarify the location, size and number of stones. For patients with suspected renal colic, urinalysis is a very important test. Gross or microscopic hematuria occurs in about 85% of cases, but the absence of microhematuria does not rule out the possibility of renal colic. The onset of renal colic is often accompanied by an increase in white blood cell count.

Differential diagnosis of renal colic

This disease should be distinguished from acute abdomen: patients with renal colic frequently change their positions to relieve pain, while patients with acute abdomen often try to stay in a fixed position.

Renal colic treatment

The primary task of patients with renal colic is to relieve pain and relieve spasm of the renal pelvis and ureter smooth muscle. For patients who are dehydrated due to nausea and vomiting, venous channels can be established to replenish water and electrolytes, while giving analgesia and antiemetic treatment. Commonly used antispasmodics are racemic anisodamine hydrochloride, atropine, distressing, tamoxidine hydrochloride; commonly used analgesics include non-steroidal anti-inflammatory (NSAIDs) and narcotic analgesics, such as morphine, pethidine Pyridine, brinazine, indomethacin suppositories, etc. Metoclopramide is used as an antiemetic drug. At the same time, "stone removal" treatment is taken for stones. Acute renal failure may be induced if used in patients with underlying renal disease.

1. Shock wave lithotripsy (SWL)

SWL has been used to treat acute renal colic since its inception, but it is controversial. It is currently believed that the use of SWL to treat stones with renal colic is reasonable. The best indication for ureteral stones SWL is stones smaller than 1 cm. During the treatment, pay attention to careful observation. The stones can be crushed to avoid excessive impact.

2. Ureteroscopy

For ureteral stones larger than 1 cm, it is sometimes used as the treatment of choice when treating distal ureteral stones (below the iliac vessels). After ureteral stone removal, a ureteral catheter should be placed, even if stone removal fails.

3. For urolithiasis with other lesions

Such as congenital malformations of the urinary system (such as horseshoe kidney, ureteropelvic junction obstruction), renal tuberculosis, ureteral stricture, stones caused by cancer, etc., open surgery should be performed.

4. Eliminate the cause

While removing the stones, the cause of urolithiasis should be actively treated.