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Renal colic is the pain associated with the passage of a kidney stone through the urinary tract. It is said to be one of the most excruciating painful events that a person may endure in life. The pain onset is sudden and severe, occurring in the lower back, either on one side or on both sides. It typically goes from loin to groin, and may radiate down to the testis (men) or labia (women).
What causes renal colic?
Causes of Renal Colic
Kidney stones (renal calculi) form within the kidneys where they are usually painless. It may travel down into the ureters, the tubular structures that carry urine from the kidneys to the bladder. These stones are made up of aggregates of crystals and may be of different types, of which calcium oxalate and phosphate stones seem to be most common. The other types of stones may consist of magnesium ammonium phosphate (struvite), cystine or uric acid.
What are the symptoms with renal colic?
Other Signs and Symptoms
Kidney stones (renal calculi) may be present for years without giving rise to any symptoms but when a stone becomes impacted in the ureter, an attack of renal colic develops. The pain may become excruciating within a few minutes, giving no relief with change of position. It may be accompanied by pallor, nausea, vomiting, sweating, and fever.
Dysuria (difficulty in passing urine) and hematuria (blood in the urine) may be present. The intensity of pain remains constant throughout the attack or the pain may come in spasms. It usually lessens within a couple of hours, but may continue for hours or days. The pain of renal colic is said to be one of the most agonizing types of pain that a person can feel. Following the acute attack, there may be persistent dull pain in the loin or lower back.
How is renal colic diagnosed?
Diagnosis of Renal Colic
Renal colic is usually diagnosed from the history and by finding red blood cells in the urine. Blood tests and urine tests, including a 24-hour urine test should be done. Further investigations are necessary to determine the site and size of the stone and the degree of obstruction.
- A plain abdominal x-ray can detect most stones since almost 90% of them are radio-opaque.
- Intravenous pyelogram (IVP), which is an x-ray of the kidney, ureter, and bladder after introducing a radio-opaque dye intravenously, is less often used nowadays.
- An ultrasound may help to identify a stone and rule out other possible causes of pain.
- A helical CT scan without contrast material is highly effective in diagnosing urinary stones.
How is renal colic treated?
Treatment of Renal Colic
Bed rest and application of warmth to the site of pain should be the immediate treatment, to be followed by pain relievers such as diclofenac.
- Intramuscular morphine or pethidine may be necessary in case of severe pain and antiemetics for nausea and vomiting.
- Antispasmodics help to relax the muscles in the urinary tract and may help to relieve pain.
- Plenty of fluid (oral intake)is advisable and small stones are likely to pass out spontaneously in the urine.
- Antibiotics may be necessary to control or prevent infection.
- Corticosteroids reduce inflammation and therefore decrease pain and swelling.
Surgery
Persistent and unbearable pain that does respond significantly to medication may require surgery. This may include :
- extracorporeal shockwave lithotripsy (ESWL) to break up large stones by ultrasonic waves.
- ureteroscopy and stent insertion to open up and keep a narrowed portion of the ureter opened.
- percutaneous nephrostomy to relieve an obstruction.
- percutaneous nephrolithotomy (PCNL) to remove stones by keyhole surgery.
How is renal colic prevented?
Prevention of Renal Colic
- Drinking plenty of fluids.
- Restricting sodium intake.
- Moderate protein in diet
- Normal calcium diet.
- Avoid foods rich in oxalate may help to prevent calcium stones.
- Urine alkalinization and drugs such as thiazide diuretics and allopurinol are used in specific cases.
- Vitamin D supplements should be avoided since it increases calcium absorption and excretion.
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