Renal colic

Renal colic is a syndrome observed in a number of kidney diseases, the main manifestation of which is acute pain in the lumbar region.

Etiology and pathogenesis. The most common causes of renal colic are renal stone disease, hydronephrosis, nephroptosis, in which urodynamics in the upper urinary tract is disrupted. Renal colic can cause obstruction of the ureter with a blood clot, kazoosic masses in kidney tuberculosis, a tumor, as well as polycystosis and other diseases of the kidneys and ureters. The leading role in the development of the symptom complex belongs to spasm of the urinary tract with their ischemia, dilatation of the fibrous capsule of the kidney, and pulmonary-renal reflux.

Symptoms, treatment. The attack most often develops unexpectedly in the form of severe pain in the lumbar region, but sometimes it is preceded by growing discomfort in the kidney area. Walking, running, riding a motorcycle, lifting heaviness often provoke an attack, but it can also arise in peace. The intensity of pain rapidly increases, the patient rushes, finding no place in pain, moans loudly, holding hands with his aching side. Pain localizes in the lumbar region, but then moves down the ureter, irradiates into the groin and genitals. When examining urine, as a rule, there are erythrocytes and a small amount of protein, sometimes - concrements, salts, blood clots. Often, with stones of the ureter, renal colic is accompanied by pain in the abdomen, paresis of the intestine, like a picture of an acute abdomen. In such cases, differential diagnosis with appendicitis, cholecystitis, intestinal obstruction and pancreatitis is not easy, especially since the attack is often accompanied by nausea and vomiting, and the presence of erythrocytes in the urine does not exclude the presence of appendicitis. If a small stone is localized in the lower part of the ureter or renal colic is associated with the removal of sand, then there are frequent, painful urge to urinate. The attack can be accompanied by chills, fever, tachycardia, leukocytosis, an increase in ESR. It can quickly end or last for many hours.

The diagnosis of renal colic is based on the characteristic localization and pain irradiation, which is enhanced by palpation and effleurage in the kidney area, on the basis of changes in urine, given chromocystoscopy and intravenous urography. With kidney stone disease and hydronephrosis, an attack can occur both during the day and at night (the patients sleep on any side), with nephroptosis, pain occurs more often in the daytime (patients prefer to sleep on the sore side). With chromoscystoscopy during an attack, indigocarmine is not isolated from the patient side or its release is significantly delayed. Sometimes, in the mouth of the ureter, bullous edema, hemorrhage, or strangulated stone are seen. Outside attacks with hydronephrosis, indigo carmine secretion is always slow, and with nephroptosis, as a rule, normal.

Intravenous urography is the most valuable method of diagnosing renal colic and its differential diagnosis with acute surgical diseases of the abdominal cavity. It allows for nephrolithiasis to detect a stone and changes in the urinary tract, with hydronephrosis - enlargement of the pelvis and calyces, and with nephroptosis - pathological displacement of the kidney and bending of the ureter. Intravenous urography also reveals other, more rare causes of renal colic.

Treatment begins with the use of heat (hot-water bottle, bath temperature 37-39 "C), spasmolytic and analgesic agents.The attack can be stopped by intramuscular injection of 5 ml of the solution of baralgina in combination with ingestion of oralgin 0.5 g 3 times a day or subcutaneous injection 1 Ml of a 0.1% solution of atropine in combination with 1 ml of a 2% solution of promedol or 1 ml of a 2% solution of pantopone (or 1 ml of a 1% solution of morphine.) With a prolonged seizure, a novocaine blockade of the spermatic cord (round ligament of the uterus) is advisable on the side of the lesion. Renal colic, accompanied by an increase in temperature, is an indication for hospitalization in the urological department, where a catheterization of the ureter can be performed with a therapeutic purpose.

The prognosis with timely and adequate treatment is favorable.