Renal colic

Renal colic is a set of symptoms that occurs when the drainage of urine from the kidneys is difficult or impossible. As a result, the renal pelvis fills with urine, its walls stretch under pressure, the smooth muscles of the ureters contract convulsively, causing spasms, the tissues swell, the blood vessels supplying the kidney narrow, and the kidney experiences a lack of oxygen, which only aggravates the situation. The person experiences acute pain. It is believed that the pain during renal colic is one of the most severe that a person can experience, and the intensity of the impact exceeds even childbirth.

How does renal colic develop?

Acute phase. Renal colic occurs suddenly. If the patient is sleeping at this time, he wakes up from pain. If awake, the patient can usually name the exact time of onset of renal colic. The occurrence of renal colic does not depend on physical activity, but its appearance can be facilitated by a large volume of liquid drunk the day before, taking diuretics, stress experienced by a person, a bumpy road or a rich meal.

The pain is constant and may get worse over time. Gradually, the intensity of pain increases, until its apogee a few hours after the onset of renal colic. The level of pain depends on the individual sensitivity of the person, as well as the rate of increase in fluid pressure in the renal pelvis and ureter. If the frequency of contractions of the ureter increases and the obstruction causing urinary retention moves, the pain may intensify or return.

Constant phase. When the pain reaches its limit, it remains at that level for a long time. Typically this phase, which is very painful for the patient, lasts from one to four hours, but in some (fortunately quite rare) cases it can last up to twelve. As a rule, it is during the constant phase that patients go to the doctor or go to the hospital.

Decay phase. During this period, the pain decreases until it stops completely and the person finally feels better. The pain may stop any time after the onset of renal colic.

Symptoms of renal colic

How to distinguish renal colic from pain caused by other diseases? The most important sign of renal colic is the nature of the pain. Pain with renal colic always occurs suddenly and sharply. First, a person feels a twinge of pain in the side, lower back, or in the area of ​​the lower ribs near the spine. Gradually, the pain intensifies, its localization changes: from the initial place of occurrence it goes down to the genitals, and can affect the rectum and upper legs. Often, the lower the pain, the stronger it is. Patients often say that they feel constant pain with sharp and severe cramping attacks. A person is unable to find a position in which he would not experience pain, and is forced to walk back and forth even at a doctor’s appointment. And the pain associated with renal colic is long-lasting; an attack can last from three to eighteen hours.

Depending on the disease that caused renal colic, the symptoms accompanying it may vary. As a rule, patients experience a frequent urge to urinate, with very little or no urine, and cutting pain in the bladder and urethra. The patient's mouth becomes dry, he feels nauseous and vomits, but neither nausea nor vomiting brings relief. The pressure rises, the heart rate increases. As a result of the accumulation of gases in the intestines, the abdomen swells, and the patient experiences the urge to defecate. The temperature rises slightly, and the person may feel chills.
Very severe pain with renal colic can lead to the development of pain shock. The patient turns pale, the heart rate decreases, and cold sweat appears on the skin.

After the end of the painful attack, a large volume of urine is released. However, due to the presence of blood in the urine, its color may become reddish. But even if the urine looks ordinary, traces of blood can be detected under a microscope.

Renal colic in children

Unlike adults, in young children pain from renal colic is felt in the navel area. The attack does not last long, 15-20 minutes, the child is frightened, cries, vomits, and the body temperature rises slightly.

Renal colic in pregnant women

Chronic diseases often worsen during pregnancy, and kidney disease is no exception. As a rule, pregnant women develop renal colic in the third trimester. The pain usually begins in the lower back and can radiate to the hips and genitals. If renal colic occurs, you should immediately consult a doctor, as there is a danger of premature birth.

Causes of renal colic

One of the most common causes of renal colic is mechanical obstacles to the passage of urine. In most cases, a kidney stone (stone) gets stuck in the ureter. In case of pyelonephritis, instead of a stone, the ureter is blocked by inflammatory products - clots of mucus or pus, and in case of kidney tuberculosis - dead tissue. With nephroptosis, kidney dystopia, strictures, the ureter may twist, bend, or its lumen is so small that urine output is difficult. Sometimes the ureter can be affected from the outside by pinching it, tumors of the kidneys, ureter, prostate gland, as well as hematomas after injury or surgery.

Sometimes renal colic occurs due to inflammation of the urinary tract, for example, with hydronephrosis, periureterin, prostatitis, and so on. Renal vein thrombosis, renal infarction and embolism can also be accompanied by renal colic. And, of course, congenital defects in the genitourinary system, caused by impaired fetal development in the womb, can also contribute to the development of renal colic.

When to seek medical help for renal colic

At the first symptoms of renal colic (especially if it occurs on the right side), it is recommended to immediately call an ambulance, otherwise there is a high risk of serious complications, including the death of the kidney, the occurrence of chronic renal failure and even the death of the person. It is advisable not to take medications, as they can blur the clinical picture and prevent the doctor from diagnosing the disease that caused renal colic.

Urolithiasis as one of the most common causes of renal colic

Urolithiasis (nephrolithiasis or urolithiasis) is a common disease that affects 5 to 15% of the population. It is caused by kidney stones, or calculi, which, if stuck, going down from the kidney through the ureters, can cause renal colic in a person. ICD is highly recurrent - approximately half of the total number of patients are susceptible to recurrent stone formation if they do not prevent the disease. More than 70% of cases of renal colic caused by stones occur in people between 20 and 50 years of age, more often in men than in women (2 to 1 ratio). There are several prerequisites for the possible formation of stones.

The most common of them are the following:

• Insufficient urine output. If the amount of urine produced by the patient is no more than 1 liter per day, the urine becomes more concentrated and may stagnate, which leads to its oversaturation with dissolved substances and, as a result, the formation of stones.

• Hypercalciuria. The reasons for its occurrence have not yet been studied. It is believed that this condition may be a consequence of increased calcium absorption into the blood, increased calcium levels in the blood, hypervitaminosis D, hyperparathyroidism, eating a high protein diet, or systemic acidosis. Hypercalciuria increases the saturation of urine with calcium salts such as oxalates and phosphates, which leads to the formation of crystals. Approximately 80% of kidney stones contain calcium.

• Elevated levels of uric acid, oxalates, sodium urate, or cystine in the urine. Stones with uric acid salts account for 5 to 10% of all kidney stones. Often this urine composition is the result of a diet high in protein, salts and oxalate esters (oxalates), or a genetic disorder that causes increased excretion.

• Infection. It is caused by urea-splitting bacteria (Proteus or Klebsiella species). They break down urea in the urine, thereby increasing the concentration of ammonia and phosphorus, which contribute to the formation and growth of stones. Stones of this type are called mixed (because they contain magnesium, ammonium and calcium phosphates).

• Insufficient levels of citric acid salts (citrates) in the urine. The role of citrates in urine is similar to the role of bicarbonates in blood serum. They reduce the acidity of urine, but also slow down the growth and formation of crystals. The optimal level of citrates in urine is 250 mg/l to 300 mg/l.

• Obesity, hypertension, diabetes. All these diseases contribute to the formation of kidney stones and, as a result, the appearance of renal colic in humans.

Complications of renal colic

As the stone moves from the collecting system, it can injure the ureter, thereby promoting the formation of strictures in it, block it and cause hydronephrosis and an attack of renal colic, reduce the rate of ureteral peristalsis and promote the return and stagnation of urine in the kidneys. This in turn leads to a decrease in the rate of glomerular filtration of urine in the affected kidney and an increase in the load on the healthy one. Complete blockage of the ureter can cause acute renal failure. If left untreated within one to two weeks, the damage may be irreversible. Additionally, there is a risk of rupture of the renal calyx with the development of urinoma (urinary pseudocyst, when the urine is surrounded by a fibrous capsule and looks like a tumor). An infection that has entered the affected kidney can cause even greater concern, which ultimately leads to obstructive pyelonephritis (occurs in about a quarter of the total number of cases of renal colic) or purulent inflammation of the kidneys, pyonephrosis. In severe cases, urosepsis can develop, which can be fatal.

Prognosis for renal colic

Conditionally favorable if the patient consulted a doctor after the first symptoms of renal colic appeared, and the disease that caused it had no complications. Otherwise, everything depends on the severity of the disease, age and condition of the patient.

Emergency hospitalization for renal colic

The patient must be urgently sent to the hospital if, despite all efforts, it is not possible to reduce the pain of renal colic, the patient has both kidneys affected or only one is present, with the release of exudate (fluid that enters the tissues from the blood vessels during inflammation), or a hypercalcemic crisis.

Urgent treatment is also necessary if the stone blocking the ureter becomes infected. Such a stone acts as a source of infection and causes stagnation of urine, which reduces the patient’s chances of somehow resisting the infection. Such stones must be removed immediately and completely to prevent re-infection and the formation of new stones.

Treatment of the disease that caused renal colic

It is selected by the doctor individually, depending on the disease that caused the renal colic and the condition of the patient. If the cause is a blockage of the ureter, the obstruction can be removed with medications (dissolved or forced to come out on its own). If this is not possible, remote shock wave lithotripsy (where shock waves destroy the obstruction, and the remaining small particles are excreted in the urine on their own), contact lithotripsy (breaking up the stone using an endoscope) or percutaneous nephrolithotripsy (where an endoscope is inserted through a tiny incision in the skin) is used.

If renal colic is caused by kinking of the ureter when the kidney prolapses (nephroptosis), in the early stages of the disease the patient is recommended to wear a bandage to prevent displacement of the kidney and engage in physical exercise to strengthen the muscle frame. If these measures do not help or the situation is complicated by pyelonephritis, stones and arterial hypertension, the kidney is returned to its place surgically.

Stricture (narrowing of the canal) of the ureter can only be corrected surgically. If the stricture is small, it is removed using endoscopic surgery. If a blood vessel is pressing on the ureter, the doctor may, during laparoscopic surgery, cut the ureter, move the vessel to its back, and re-suture the ureter. If the affected areas are so large that excision is impossible, the affected fragments are replaced with fragments of the patient's own intestinal tissue.

For tumors in the abdominal cavity, one of the consequences of which is kinking or twisting of the ureter and renal colic, surgical treatment is indicated. If the tumor is benign, it is removed so that it does not undergo malignancy (that is, so that benign cells do not turn into malignant ones). For large tumors, a combination of surgery and radiation therapy is used, and if the cancer cannot be removed by surgery, chemotherapy is used.

Rehabilitation and prevention of renal colic

After relieving the attack of pain due to renal colic and treating the disease that caused it, the rehabilitation process begins. Its method is selected by the doctor for the patient, based on the nature of the disease, the age and condition of the patient, the presence of complications of the disease and pathological changes in the body. But for any diseases of the genitourinary system, it is recommended to visit a urologist at least once a year for a preventive examination, take a urine test and do an ultrasound of the pelvic organs. For patients who have undergone tumor removal, this is especially important.

Diet plays an important role in preventing the re-formation of stones, which can cause a new attack of renal colic. One of its main conditions is to drink at least 2.5 liters of fluid per day, which can significantly reduce the concentration of salts in the urine. As a rule, when dieting, the consumption of animal proteins, sweets, fats, and salt is reduced. Depending on the type of kidney stones, your doctor may further limit foods that contain substances that promote the formation of this type of stone, such as oxalates (found in apricots, tomatoes, cornmeal, etc.) or purines (beer, legumes, liver, yeast). A patient who has had pyelonphritis is advised to avoid eating fried, fatty, baked foods, dishes high in salt and spices, as well as fresh bread.

With nephroptosis, the patient is advised to follow a diet so that sudden changes in weight do not lead to a relapse of the disease, as well as to strengthen the muscle frame with regular exercise. It is usually recommended to follow diet No. 7 and individually adjust it to suit you. With nephroptosis, it is important to get enough calories so that the lack of fat does not cause new kidney prolapse and another renal colic.

For questions, you can contact us by phone +(998 71) 140-03-03, +(998 71) 140-01-60 and at the address Tashkent, Uchtepa district, 12th quarter, st. M. Shaikhzoda.