Renal colic - a syndrome that occurs due to a violation of the outflow of urine or spasm of the smooth muscles of the ureter.
This symptom can occur for many reasons, and, neither adults nor children are immune from it. As a rule, the main provocateurs of renal colic are chronic or acute diseases of the kidneys and urinary system.
One of the most common causes is urolithiasis, in which the lumen of the urinary tract is blocked by stones.
What it is?
Renal colic is a sharp pain syndrome, the focus of which is localized in the kidney or tissues of the ureter. The pain is paroxysmal in nature, and may radiate to adjacent organs and not only. With such an attack disrupts the process of digestion and urination.
The etiology of renal colic is based on:
- stretching the renal cavity and its outer shell;
- irritation and compression of the intrarenal nerve receptors;
- re-throwing (reflux) urine back into the renal pelvis;
- increased intrarenal pressure, which occurs due to violations of the outflow of fluid.
Thus, renal colic is a consequence of blockage of the ureter with a stone or accumulation of salt crystals. The syndrome can have right or left-sided (less often - bilateral) localization. It will be the same in its course and associated symptoms, but, depending on the location of the source of pain, its spread will also be different.
Renal colic can be associated with many diseases, but in all cases this pathological condition has one characteristic feature, which is obturation (blockage) of the urinary tract. Each of the diseases that are provocateurs of this syndrome leads to disruption of fluid drainage, which causes the appearance of characteristic symptoms. The urinary tract can be blocked at any level (pelvis, ureter, bladder), but this does not affect the clinical manifestations of the process.
Obturation of the urinary tract may be due to:
- ICD. In 92% of cases, the cause of such colic is the kidney calculus (stone), occluding the pelvis and ureter. If specific symptoms occur, the physician must make a diagnosis in order to confirm or exclude the presence of urolithiasis.
- Pyelonephritis. The defeat of the renal cup system is more often bacterial in nature, and is caused by a shelf of influenza, streptococci, staphylococci, Escherichia coli. In the inflammatory process, epithelium and fibrin exfoliation often occurs, followed by the formation of purulent exudate. Such a process causes obturation, and if there are several such neoplasms, they are capable of blocking the ureter completely. Pyelonephritis often develops when there is a calculus in the kidney.
- Congenital features of the organ AIM. Some patients have congenital anomalies of the development of the organs of the urinary system. For example, renal colic often occurs in people with an ureter anatomically incorrectly attached to the bladder, dystopia, or nephroptosis. Typically, such anomalies do not cause any discomfort, so a person does not know about his problem for many years. But under the influence of certain factors (injuries, infectious lesions), the outflow of urine can be disturbed, which provokes the development of renal colic.
- Injuries. With mechanical damage to the organs of the MBC, the formation of hematomas can occur, which will clog the ureter. The development of colic also often leads to channel compression.
- Tumor processes are benign or malignant in nature. The growth of tumors leads to compression of the pelvis or ureter. This happens in two cases: if the tumor is localized in the immediate vicinity of these parts of the MVS, or when it appears directly in their tissues.
The causes of renal colic can also be found in inflammatory lesions and congestive processes occurring in the urinary tract. Hydronephrosis, acute segmental swelling of the mucous membrane of the urinary organs in periurethritis, urethritis, prostatitis or phlebostasis - all these diseases can provoke the appearance of this symptom.
Renal colic is often fixed in patients suffering from renal vein thrombosis, heart attack or kidney embolism. Some congenital anomalies, accompanied by a violation of urodynamics, can also serve as a cause of this condition: achalasia, dyskinesia, megacalycosis, spongy kidney, etc.
Symptoms of renal colic
For renal colic, sudden, sharp, sharp and intense pain arising in the lumbar or rib-vertebral corner is characteristic. The development of an attack can fall on the night, in the phase of deep sleep.
Some patients associate the appearance of pain with heavy physical work, shaking while driving, long walking and other external factors. From the lumbar region, pain can spread to the mezogastral or ileal region, thigh, or rectum. In men, pain can radiate to the scrotum or penis, and in women, to the perineum or labia.
The duration of the attack can vary from 3 to 18 hours. During this time, the intensity, localization and irradiation of pain may vary. During renal colic, patients become restless in an attempt to find a position that will ease the condition.
In parallel, patients suffer from:
- frequent urge to empty the bladder (then oliguria or anuria develops);
- rezi in the field of an urethra;
- dry mouth;
- bouts of vomiting;
Subsequently, the development of tachycardia, moderate hypertension, subfebrile condition occurs. In severe cases, shock occurs, accompanied by a sharp drop in blood pressure to 50/30 mm Hg. Art. or below, bradycardia, cold, sticky sweat, blanching of the skin. After renal colic passes, there is a small amount of red blood cells in the urine.
Independently distinguish renal colic from other conditions involving abdominal pain, it is impossible. So, similar symptoms are observed in acute appendicitis, pancreatitis, cholecystitis. Patients with thrombosis of mesenteric vessels, aortic aneurysm, perforated gastric ulcer, epididymoorchitis, herniated discs may also suffer from such pain syndrome. In women, it is often associated with torsion of the ovarian pedicle or ectopic pregnancy, in men, with testicular torsion.
With ICD, the stone, moving out of the cup and pelvis system, can injure ureteral tissue. This leads to stricture formation, blockage, hydronephrosis, and renal colic. Under this influence, the velocity of ureteral peristalsis decreases, against the background of which there is a return of urine and its stagnation. The glomerular filtration rate of the diseased kidney is reduced, so the load on the healthy organ is doubled.
Complete obstruction of the lumen of the ureter can trigger the development of acute renal failure. If left untreated for 1–2 weeks, the effects of this condition may be irreversible. And that is not all. Against this background, the likelihood of rupture of the renal calyx increases, which increases the risk of the formation of a urinoma, a urinary pseudocyst that has a capsule, and urine accumulates inside it. Visually, such a neoplasm creates the illusion of a tumor.
There is also a risk of infection in the affected kidney tissue, resulting in the development of obstructive pyelonephritis, purulent inflammation of the kidneys, pyonephrosis. In severe cases, urosepsis develops, fraught with death.
To make an accurate diagnosis, the nephrologist (or urologist) first conducts a visual inspection, and a detailed patient survey. Be sure to perform palpation of painful areas, during which, the patient may experience an attack of pain in the area of the ureters on the front of the abdomen. In addition, it makes sense to hold a series of minor taps in the kidney area. Perhaps such a manipulation also provokes the appearance of pain.
After examination and interview, the doctor gives the patient directions for a comprehensive diagnosis. It consists in carrying out:
- Laboratory studies of blood and urine. In the blood of renal colic, an increase in the level of creatinine and leukocytes is noted. In parallel, an overestimated urea rate is recorded. In the urine erythrocytes are detected.
- Ultrasound of the kidneys. The procedure helps to identify calculi in the kidneys or ureters, and also studies the organs of the urinary system in order to identify pathological structural changes in their tissues.
- Excretory urography. This is an x-ray study conducted using a special contrast agent. The resulting images can be seen narrowed ureter or the presence of calculus.
- CT scan of the urinary system. X-rays of this type help to thoroughly examine the layered structure of the kidneys, ureters and bladder.
Only a comprehensive diagnosis is the key to making the correct diagnosis. And the sooner it is determined, the less will be the risk of complications.
First aid for renal colic
With an attack of renal colic, you must call the ambulance team. Before the arrival of physicians, it is necessary to carry out measures aimed at eliminating pain and stabilizing the general condition. To this end, it is recommended to abandon drugs in favor of:
- Hot bath. Water heated to 38 - 39 degrees helps to eliminate the spasm of smooth muscles. This allows you to quickly remove the attack of pain.
- Local heat. This procedure will be especially relevant for patients who, for one reason or another, do not take hot baths. Also, local heat is used if there is no time to dive into warm water. For manipulation, it is necessary to warm the water, pour it into a heating pad or bottle, which then must be applied to the sore spot. Keep until water is cool. If necessary, the procedure can be repeated.
- Antispasmodic drugs. Such medications relax smooth muscles, thereby helping to eliminate pain syndrome. In special cases, under their influence may even occur self-discharge of calculus. The most commonly prescribed medication is No-Shpa (the active substance is drotaverine) at a dose of 160 mg.
- Analgesic medicines. Pain medications are prescribed only in the case of left-sided localization of renal colic, because if the pain is localized on the right side, then they can be associated not only with nephrological diseases. Right-sided pain syndrome may be associated with an acute attack of appendicitis, cholecystitis, peptic ulcer disease, etc. If you take an anesthetic pill in this case, you can significantly blur the clinical picture of the disease. To make an accurate diagnosis in this case will be extremely problematic. If there is really renal colic, then in such a situation it is advisable to take drugs based on ibuprofen, paracetamol. Baralgin and Ketanov will also be effective.
Renal colic treatment
Renal colic is a condition that requires urgent medical intervention. At home, only taking pain medication is allowed, but after that, an “ambulance” must necessarily be called, as pain killers cannot prevent the development of acute inflammation of the abdominal cavity.
Eliminate pain in renal colic helps warm warmer. Especially electric. It is placed on the side, in the part of the spine where the source of intense pain is localized, and heated to the desired temperature. This contributes to the expansion of the ureter, which, in turn, can cause the stone to descend under pressure from the renal fluid. In some cases, this manipulation prevents surgical intervention.
The operation to remove calculus is necessary for:
- complicated urolithiasis;
- the ineffectiveness of drug treatment;
- stone size is greater than 1 cm. In this case, the operation is assigned, provided that after 3 days from the onset of the attack, the calculus itself has not moved.
Since most often this symptom is a sign of ICD, the main task of the surgeon is the surgical removal of the renal stone.
In order to avoid re-development of renal colic, the patient should pay special attention to their diet. The diet is prescribed according to the type of stones:
- Uratny stones. In this case, it is recommended to exclude nuts, chocolate, legumes, cheese. Salty dishes, sour berries, strong brewed tea will have a negative impact on health.
- Phosphate stones require the exclusion from the menu of potatoes, cottage cheese, dairy and fish products. You can not get too carried away with berries and fruits.
- Cystine stones. In this situation, it is necessary to limit the consumption of beans, chicken, peanuts, eggs, corn products.
- Oxalate stones. Meat, sorrel, sour foods are prohibited. In moderate quantities allowed the use of citrus fruits, legumes, beets, tomatoes.
Of great importance is drinking mode. Drinking with renal colic need from 2.5 to 3 liters of fluid.
With small and smooth stones less than 6 mm in diameter, renal colic is not an indication for surgery. Usually such stones go out on their own. The prognosis worsens significantly when spiky growths form on the surface of the stone.
If the chopping is protracted, and it cannot be eliminated with the help of medicines, then in-patient is undergoing catheterization. It is necessary to restore urine outflow and prevent its stagnation.
With the ineffectiveness of conservative therapy, doctors resort to surgery to remove a kidney stone. It is carried out through open surgery with dissection of the anterior abdominal wall and extraction of calculus. But, fortunately, the need for a radical method of treatment of ICD, accompanied by renal colic, is extremely rare.
To prevent the development of renal colic, experts recommend following these rules:
- use products richly enriched with retinol and calciferol (vitamins A and D, respectively);
- monitor the level of calcium in the body, to prevent its decline (this will help food and special calcium drugs);
- during the day it is necessary to drink at least 2 liters of pure water (other drinks and liquid food are not considered!);
- timely identify and treat any renal pathologies;
- lead a physically active lifestyle.
In parallel with this, it is necessary to remember that the following factors affect the organism extremely negatively:
- alcohol abuse;
- tobacco smoking;
- urological infections;
- viral diseases of any etiology;
- injuries of the lower segment of the ridge, in the area of the projection of the kidneys;
In order not to face such an unpleasant condition as renal colic, these factors should be avoided.
Patients who have previously experienced urolithiasis, must adhere to the recommendations or prescriptions given by the doctor. It is important to periodically examine the kidneys to assess their functioning and timely detect the first signs of a dangerous pathology.