What is renal colic: symptoms in women and treatment. Renal colic - causes, symptoms, diagnosis, treatment, diet Renal colic causes symptoms emergency treatment

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How can you help a person if he has an attack of renal colic, and he cannot find a place for himself because of the pain tearing him to pieces? Renal colic cannot be treated at home, but you need to know what to do in order to significantly alleviate the patient's condition and try to relieve acute spasms of the pain that torments him. Colic in the kidneys can be caused by a variety of reasons, and first aid measures should be known to relatives and friends of a person suffering from pathological diseases of the genitourinary system so that he does not suffer from painful shock at the acute stage of colic.

What is renal colic

The resulting sharp pain in the lumbar region, acute impairment of renal function, is called colic. The attack begins suddenly, at any time of the day or night. Colic develops when the cup cavity of the kidney overflows as a result of delayed outflow of urine. Stretching of the kidney and an increase in pressure in it contribute to the occurrence of severe pain syndrome, which is a consequence of the pathology that has arisen. Such an attack can last from several minutes to a week, turning a person's life into torment in the absence of therapeutic measures.

Renal colic symptoms

Kidney dysfunction syndrome can be accompanied by the following symptoms:

• acute pain attack in lumbar on one or both sides;
• the presence of blood, sandy suspension in the urine;
• frequent urination, pain when emptying the bladder;
• the spread of painful foci to the lower parts of the body - the inguinal zones, the inner surface of the thighs;
• deficiency of urination;
• bloating in the lower abdomen;
• nausea, vomiting, weakness;
• diarrhea, or vice versa, constipation;
• restless behavior.

Pain

Violation of the blood supply to the kidney, the loss of its functions leads to acute and sharp attacks of pain, the localization of which can manifest itself in different places - in the lower back on the right or left side. Painful sensations radiate (spread) to the groin area, to the lower abdomen, external genitals, inner thighs. Distinguish between left-sided and right-sided renal pain syndrome. If it is possible to relieve the attack, then the intensity of the pain subsides, but weak painful sensations persist.

In children

In babies who themselves cannot yet speak, colic can be recognized by increased anxiety, tearing crying, and a swollen tummy. The attack can last 5-15 minutes, in some children vomiting appears. If the child can speak, then, when asked about the location of pain, the umbilical, lumbar, and groin areas are indicated. Since cramping pain can indicate serious pathologies that are fraught with serious complications, the child should be immediately shown to a doctor.

Causes

Colic can occur with the following pathologies:

• accumulation of kidney stones and blockage of the urinary tract by them;
• with bends and narrowing of the urethra, ureter (observed in men);
• in pregnant women, the fetus can provoke a pinching of the kidney;
• prolapse of the kidney (nephroptosis);
• acute pyelonephritis and other kidney diseases;
• tumors internal organs;
• colitis;
• abnormal structure of the organs of the urinary system;
• allergies while taking various drugs;
• tuberculous kidney damage.

Diagnostics

To identify the pathology that caused the acute pain syndrome, the doctor must draw up an anamnesis of the disease, conduct differential diagnostics, ask the patient about the nature of the pain, the time of its occurrence, localization, accompanying symptoms(whether there was blood in the urine, problems with urination). Also, a nephrologist can ask about illnesses suffered during his life, which were accompanied by a malfunction of the genitourinary system, the presence of pyelonephritis, about how much liquid the patient drinks, whether he has an addiction to salty foods.

After drawing up a medical history, the doctor proceeds to practical diagnostic methods:

• A primary visual examination of the patient is carried out, a careful palpation of the painful area is done.
• Blood and urine are taken for analysis. An acute inflammatory process may be indicated by an increase in the number of leukocytes in the blood and urine, the presence of creatinines and erythrocytes in the urine.
• An echographic examination of the kidneys is done in order to identify the location, structure, localization of the calculus in these organs.
• The study is carried out by the method of excretory urography.
• Sometimes computed tomography of the urinary tract is done in order to identify the cause of colic.

Treatment

To stop an attack of colic with renal dysfunction, you need to know what pathology caused this syndrome and eliminate it. Semi-fainting state of the patient, nausea, vomiting require immediate hospitalization and restoration of renal capacity in stationary conditions. If the presence of appendicitis, hepatic colic is not detected, then doctors simultaneously take measures to relieve pain and eliminate the cause of the disease.

The patient may be prescribed drugs that alkalinize urine and dissolve stones, a special diet. In this case, you will have to drink multivitamin complexes, diuretics, which eliminate the likelihood of kidney stones formation. If the cause of colic was renal tuberculosis, then special medications are prescribed to get rid of the pathology. Surgical invasive intervention is indicated in the absence of the effect of drug treatment.

First aid for renal colic

It is important to correctly diagnose the disease, since other, no less serious, formidable diseases can be mistaken for colic in renal dysfunctions - acute appendicitis, pancreatitis, intestinal obstruction. If it is established that the patient suffers from colic, then at home the treatment of renal colic and first aid to eliminate the symptoms of the disease may consist of the following methods:

• Heating the sore spot with a heating pad or taking a warm bath. The heat causes the ureter and urethra to dilate, which can reduce pain at home.
• Taking antispasmodic, NSAIDs that have a relaxing effect on smooth muscles and eliminate colic.
• An abundant warm drink.

Renal colic medications

To stop an acute attack, doctors prescribe the following groups of drugs:

• antispasmodics;
• pain medications;
• antiemetic drugs;
• medicines to reduce urine output (to reduce pressure in the renal pelvis);
• means that help dissolve stones and calculi.

Of the drugs that help get rid of stones in the urethra and ureter, the following can be distinguished:

• Potassium citrate. Helps maintain the correct salt balance in urine to effectively dissolve stones. The dosage is assigned individually, with constant monitoring of urine analysis. You can take no more than 50 meq of medicine per day.
• Bicarbonate of soda. The solution will help dissolve the urates. The required concentration of the drug is prescribed by the doctor, you need to take a teaspoon three times a day for 2-3 months with constant monitoring of urine analysis.

Pain reliever

To relieve acute unbearable pain, doctors use the following drugs:

• Baralgin. Effectively promotes elimination pain by relaxing muscle spasms. With colic of renal origin, 5 ml of intramuscular or intravenous administration is prescribed every 4-6 hours.
• Ketorolac. An excellent pain reliever that reduces inflammation and relieves fever. With colic, do i / m injections of 60 mg every 3-5 hours until the attack disappears completely.

Antispasmodics

Together with pain relievers, doctors use antispasmodics for renal colic, which effectively eliminate pain. This group of drugs includes the following drugs:

• Atropine. The use of the agent helps to relax the smooth muscles of the kidney, while the pain subsides, the patient feels better. Shown in / m injections with a concentration of up to 1 mg of atropine daily.
• Hyoscine butyl bromide. Reduces the tone of smooth muscles, relieves urinary tract spasm. In case of acute pain syndrome, a dropper is made with 20-40 mg of the active substance for adults, 5-10 mg for children, three times a day before the colic disappears.

No-shpa

Drotaverine has a hypotensive, antispasmodic effect, relaxes the smooth muscles of the kidneys. In an acute attack of colic, 3-4 tablets are shown at a time to relieve pain spasms. However, one should not count on the complete elimination of renal failure with a single dose of No-shpa at home. If colic is accompanied by vomiting, fever, then you should immediately call an ambulance for hospitalization of the patient.

Surgery

Surgery is indicated in the following situations:

• with complications of urolithiasis;
• dropsy of the kidney (hydronephrosis);
• stones and calculi of large diameter;
• lack of effect from previous therapy.

There are several methods of surgical treatment for colic:

• Contact and extracorporeal lithotripsy. The operation is performed on an outpatient basis, the stone is crushed by directional ultrasound remotely or by contact, with the introduction of a thin tube to the site of the stone dislocation.
• Percutaneous nephrolithotomy. A puncture is made on the skin, into which a special instrument is inserted, with which the stone is removed.
• Open operation. It is used only when the overflow of the renal pelvis has caused purulent lesions of the renal parenchyma and tissue necrosis.

Folk remedies

To stop colic, you can use the following folk recipes:

• Mix in a 1: 1 ratio dry birch leaves, mint, juniper fruits. Take 6 tbsp. l. mixture, pour a liter of boiling water, leave in the dark for 30 minutes. Drink the solution in 1 hour.
• 8 tbsp. l. pour fresh birch leaves and buds with a liter of water and cook in a water bath for 20 minutes. Drink the infusion in 1-2 hours.

Prophylaxis

You can try to avoid acute attacks of pain in renal dysfunction by observing the following rules:

• timely treat diseases of the genitourinary system;
• regularly undergo examinations by a nephrologist;
• avoid hypothermia and drafts;
• alternate sedentary and active lifestyles;
• drink at least 2 liters pure water per day;
• take complexes containing calcium, vitamins A, C, E, D.

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An acute attack of pain in the lumbar region, like a spasm, is a sign of kidney pathology, it knocks out any person from the usual rhythm of life. Urgent care for renal colic plays a major role in the correct relief of a painful attack, and should be provided immediately. Correctly provided assistance will improve the healing process and help doctors in a short time to settle the general condition of a person.

Urgent care

First aid for renal colic should be competent and timely. It is necessary to follow the correct algorithm for carrying out special procedures. It is important to understand that only with a clear conviction in the diagnosis can independent steps be taken and used medications, otherwise, you need to urgently seek help from doctors.

What to do with renal colic in the first minutes?

The provision of emergency first aid at home is possible with a clear knowledge of all methods of localizing colic. At the first stage, pain can be relieved by applying thermal methods and special medications. The sequence of procedures is as follows:

• to summon ambulance;
• create a calm environment;
• to establish the place of localization of pain;
• track possible temperature changes;
• collect urine.

To remove spasms and restore the normal outflow of urine is the result for which all procedures are carried out with first aid help. The kidneys are very susceptible to heat, so the patient must be provided with warm objects: wrap a blanket, put a heating pad. As a rule, warming the place where the pain appears, leads to its decrease or complete cessation.

How to relieve pain with drugs?

After carrying out thermal procedures, the patient can be administered painkillers or antispasmodics. Medicines can be in the form of pills and injections. Antispasmodics for renal colic relieve the tone of the muscles of the ureter, improving the patency of the ducts. Most often, myotropic drugs are used for renal colic (No-Shpa, Papaverin, etc.). If you are worried about acute pain, pain relief is best done with the help of combined drugs ("Spazmonet", "Baralgin", "Avisan" and others). Let's take a closer look at the frequently used ones.

"No-Shpa" ("Drotaverin")

The most popular drug that is always at hand. It can be taken not only as medicine for renal colic, but also to relieve any pain. By decreasing the supply of calcium to muscle cells, the drug reduces muscle tone. To relieve renal colic, you can drink 4 tablets at once, but in case of emergency, to relieve an attack of renal colic, you must inject the drug intramuscularly.

"Baralgin"

The drug is strong (stronger than "No-Shpa"). The effect of tablets (0.5-2 pcs. Several times a day) is much slower, because they have to go all the way of digestion. The solution (2 ml) enters the bloodstream immediately, so injections for renal colic are more effective. The drug contains a sufficiently large dosage of components, and in order to avoid lowering blood pressure, it should be administered very slowly. At intramuscular injection(5ml-1 ampoule) the solution, entering the bloodstream, begins to act in a few minutes.

It is forbidden to remove the spasm using "Analgin". It can distort the manifestation of symptoms, thereby complicating the diagnosis of the disease.

"Ketorol" (KETOROL)

It is possible to remove renal colic at home with Ketorol only with firm conviction correct diagnosis... The drug helps to remove pain, but along the way it will lubricate all the symptoms. For home treatment, "Ketorol" is injected intramuscularly. The injection is done slowly (within half a minute), the result comes in 30 minutes.

"Platyphyllin"

Refers to drugs that act on cells (cholinergic receptors) in which neuromuscular transmission is carried out. It is well tolerated, but not very effective (it resembles Papaverine in action). The relief of an attack is carried out by subcutaneous injection of a 0.2% solution (1-2 ml).

Contraindications and restrictions

When providing emergency care, it is important to remember that any method that eliminates kidney pain has its own contraindications. Any intervention for renal colic at home should be supported by knowledge:

1. It is necessary to ask the patient about any contraindications or allergic reactions to medications.
2. It is important to understand that it is impossible to treat colic with drugs without the supervision of a doctor. They are used as an aid to relieve an attack of kidney stones. Their prolonged use can lead to poor health. Pain is a symptom of a disease that requires a complete examination and treatment.
3. The use of thermal procedures is prohibited for inflammatory processes.
4. If an elderly person has a painful attack, it is better to use not a bath with warm water, and a heating pad. This approach will prevent the development of a heart attack.

After providing first aid, you must call a doctor, or deliver the patient to the clinic.

When is hospitalization required for renal colic?

The decision on hospitalization is made based on the patient's symptoms and well-being.

The suspicion of renal colic requires quick action, and an ambulance will transport the patient to the clinic quickly and under professional supervision. Hospitalization is indicated in any case, because kidney stones, having changed their position, can clog the ducts, and the attack will recur. Even with good dynamics, the patient is observed in the hospital for 3 days. There are situations in which hospitalization is required:

• The pain after the use of drugs does not go away.
• Deterioration of well-being:
  • vomit;
  • violation of urination;
  • complete absence of urge to urinate.
• Pain on both sides.
• Accession of the inflammatory process, which is confirmed by the increased temperature.
• With a physiological feature (one kidney in humans).

If the relief of renal colic at home has been successful, and the person refuses to be hospitalized, then it is recommended to him diet food, warmth in the back and control when urinating. It is important to collect urine in a clean container to track the presence of sediment or calculus. But it is advisable to be examined by a urologist in order to exclude the development of complications.

The task of the doctor with renal colic is to relieve the painful attack as quickly as possible.

If painkillers for renal colic did not relieve acute painful sensations, and the duration of renal colic reaches several hours and no improvement is expected, the main task of doctors is to remove the attack in a short time. Interviewing the patient will provide information about what kind of first aid was undertaken, which helps in making a decision on the further treatment of the patient.

As a rule, relief of an attack always begins with analgesics or antispasmodics. With a prolonged attack, droppers from complex medicinal mixtures or novocaine blockade can help. While they are dripping, the nurse performs an independent intervention (monitors the patient's condition). At this time, a dropper from "Baralgin" No-shpa, "Platifillin", glucose is shown, also intramuscular injections of "Analgin", "Pipolfen", "Platifillin", additionally appoint "Promedol", "Dimedrol", "Papaverin", "No -shpa ".

Further therapy consists in finding out the causes of colic and the degree of obstruction of the urinary system. Dependent interventions (sampling of material for laboratory tests) are mandatory. If renal colic proceeds against the background of an inflammatory process, the doctor will definitely prescribe an antibiotic to drink, most likely they will prescribe broad-spectrum antibiotics. Rapid elimination of infection in the case of urolithiasis is not always possible to achieve, therefore, drugs are prescribed before the removal of calculus from the body. If edema is present, diuretics are prescribed.

Chills occur in the case of a sharp increase in pressure in the renal pelvis, which leads to the development of pyelovenous reflux ( return flow of blood and urine from the renal pelvis and calyces into the venous network). The entry of decomposition products into the blood leads to an increase in body temperature up to 37 - 37.5 degrees, which is accompanied by tremendous chills.

Separately, it should be mentioned that after an attack of renal colic, when the ureteral occlusion is eliminated, the pain syndrome becomes less pronounced ( the pains become aching) and a relatively large amount of urine ( the accumulation of which occurred in the pelvis of the affected kidney). Impurities or clots of blood, pus, and sand may be seen in the urine. Sometimes small stones may come out with the urine, a process sometimes called "stone birth." In this case, the passage of a stone through the urethra can be accompanied by significant pain.

Diagnosis of renal colic

In most cases, for a competent specialist, the diagnosis of renal colic is not difficult. This ailment is assumed even during a conversation with a doctor ( which in some cases is sufficient for diagnosis and treatment initiation), and is confirmed by examination and a number of instrumental and laboratory analyzes.

It is necessary to understand that the process of diagnosing renal colic pursues two main goals - establishing the cause of the pathology and differential diagnosis. To establish the cause, it is necessary to undergo a series of tests and examinations, as this will allow more rational treatment and prevent ( or delay) repeated exacerbations. Differential diagnosis is necessary in order not to confuse this pathology with others with a similar clinical picture ( acute appendicitis, hepatic or intestinal colic, perforated ulcer, mesenteric thrombosis, adnexitis, pancreatitis), and to prevent incorrect and untimely treatment.


Due to the pronounced pain syndrome, which forms the basis of the clinical picture of renal colic, people with this ailment are forced to seek medical help. During an acute attack of renal colic, a doctor of almost any specialty can provide adequate assistance. However, as mentioned above, due to the need to differentiate this ailment with other dangerous pathologies, first of all, one should contact the surgical, urological or therapeutic department.

Be that as it may, the most competent specialist in the treatment, diagnosis and prevention of renal colic and the causes that caused it is a urologist. It is this specialist that should be consulted in the first place if you suspect renal colic.

If renal colic occurs, it makes sense to call an ambulance, as this will allow you to start treatment earlier, aimed at eliminating pain and spasm, and also speed up the process of transportation to the hospital. Also, the ambulance doctor medical care makes preliminary diagnostics and sends the patient to the department, where he will be provided with the most qualified assistance.

Diagnosis of renal colic and its causes is based on the following examinations:

• survey;
• clinical examination;
• ultrasonography;
• X-ray research methods;
• laboratory examination of urine.

Survey

Correctly collected disease data suggest renal colic and possible reasons its occurrence. During a conversation with a doctor, special attention is paid to symptoms and their subjective perception, risk factors, as well as comorbidities.

During the survey, the following facts are found out:

• Characteristics of pain sensations. Pain is a subjective indicator that cannot be quantified, and the assessment of which is based only on the verbal description of the patient. For the diagnosis of renal colic, the time of onset of pain, its nature ( acute, dull, aching, constant, paroxysmal), the place of its distribution, the change in its intensity when changing the position of the body and when taking pain medications.
• Nausea, vomiting. Nausea is also a subjective sensation that a doctor can only learn about from the patient's words. The doctor must be informed when the nausea appeared, whether it is associated with food intake, whether it is aggravated in some situations. It is also necessary to inform about episodes of vomiting, if any, about their connection with food intake, about a change in the general condition after vomiting.
• Chills, increased body temperature. It is necessary to inform the doctor about the developed chills and about the increased body temperature ( if, of course, it was measured).
• Changes in urination. During the interview, the doctor finds out whether there are any changes in the act of urination, whether there is an increased urge to urinate, whether there was a discharge of blood or pus along with urine.
• The presence of attacks of renal colic in the past. The doctor must find out whether the attack is a new-onset or if there have been previous episodes of renal colic.
• The presence of a diagnosed urolithiasis. It is necessary to inform the doctor about the presence of urolithiasis ( if there is one now, or was in the past).
• Diseases of the kidneys and urinary tract. The fact of the presence of any pathology of the kidneys or urinary tract increases the likelihood of renal colic.
• Surgery or injury to the organs of the urinary system or the lumbar region. It is necessary to inform the doctor about the previous operations and injuries of the lumbar region. In some cases - about other surgical interventions, as this allows us to suggest possible risk factors, as well as speed up the differential diagnosis ( removal of the appendix in the past eliminates acute appendicitis in the present).
• Allergic reactions. It is imperative to inform your doctor about any allergic reactions.

To identify risk factors, the following data may be required:

• diet;
• infectious diseases (both systemic and organs of the urinary tract);
• bowel disease;
• bone disease;
• place of residence ( to determine climatic conditions);
• place of work ( to find out working conditions and availability harmful factors );
• the use of any medicinal or herbal preparations.

In addition, depending on the specific clinical situation, other data may be required, such as, for example, the date of the last menstruation ( to exclude ectopic pregnancy), stool characteristic ( to exclude intestinal obstruction), social conditions, bad habits and much more.

Clinical examination

A clinical examination for renal colic provides little information, but nevertheless, when combined with a well-conducted survey, it suggests renal colic or its cause.

During the clinical examination, it is necessary to undress in order for the doctor to be able to assess the general and local condition of the patient. To assess the condition of the kidneys, their percussion can be performed - a light tapping with a hand on the back in the area of ​​the twelfth rib. The occurrence of pain during this procedure ( Pasternatsky's symptom) indicates damage to the kidney from the corresponding side.

To assess the position of the kidneys, they are palpated through the anterior abdominal wall ( which can be tense during an attack). The kidneys during this procedure are rarely palpated ( sometimes only their lower pole), however, if it was possible to palpate them completely, then this indicates either their omission, or a significant increase in their size.

To exclude pathologies that have similar symptoms, deep palpation of the abdomen, gynecological examination, digital examination of the rectum may be required.

Ultrasonography

Ultrasonography ( Ultrasound) is an extremely informative method of non-invasive diagnostics, which is based on the use of ultrasonic waves. These waves are able to penetrate the tissues of the body and be reflected from dense structures or the boundary between two media with different acoustic resistance. The reflected waves are recorded by a sensor, which measures their speed and amplitude. On the basis of these data, an image is built, which allows one to judge the structural state of the organ.


Since the quality of the image obtained during ultrasound examination is influenced by many factors ( bowel gases, subcutaneous fat, fluid in the bladder) it is recommended to prepare in advance for this procedure. To do this, a few days before the examination, milk, potatoes, cabbage should be excluded from the diet, raw vegetables and fruits, and also take activated charcoal or other drugs that reduce gas production. The drinking regimen can be unlimited.

Ultrasound examination without preliminary preparation may turn out to be less sensitive, however, in emergency cases, when urgent diagnostics are needed, the information obtained is quite enough.

Ultrasound is indicated in all cases of renal colic, as it allows you to directly or indirectly visualize changes in the kidneys, and also allows you to see stones that are not visible on X-ray.

In renal colic, ultrasound can visualize the following changes:

• expansion of the calyx-pelvis system;
• an increase in the size of the kidney by more than 20 mm in comparison with the other kidney;
• dense formations in the pelvis, ureters ( stones);
• changes in the structure of the kidney itself ( antecedent pathologies);
• swelling of the kidney tissue;
• purulent foci in the kidney;
• changes in hemodynamics in the renal vessels.

X-ray research methods

Radiation diagnosis of renal colic is represented by three main research methods based on the use of X-rays.

Radiation diagnostics of renal colic includes:

• Plain X-ray of the abdomen. A general view of the abdomen allows you to visualize the area of ​​the kidneys, ureters, bladder, as well as the condition of the intestines. However, using this research method, only X-ray-positive stones can be detected ( oxalate and calcium).
• Excretory urography. The method of excretory urography is based on the introduction into the body of a contrast X-ray-positive substance, which is excreted by the kidneys. This allows you to monitor the blood circulation in the kidneys, to assess the filtration function and urine concentration, as well as to monitor the excretion of urine through the calyx and ureters. The presence of an obstacle leads to the retention of this substance at the level of occlusion, which can be seen in the image. This method allows you to diagnose blockage at any level of the ureter, regardless of the composition of the stone.
• CT scan. Computed tomography can create images that help assess the density of stones and the condition of the urinary tract. This is necessary for a more thorough diagnosis before surgery.

Despite the shortcomings of a general X-ray image, during an attack of acute renal colic, it is he first of all done, since in the overwhelming majority of cases, stones formed in the kidneys are X-ray positive.

Computed tomography is indicated for suspected urolithiasis caused by urate ( uric acid) and coral ( more often of a post-infectious nature) stones. In addition, tomography can diagnose stones that could not be identified by other means. However, due to the higher price, computed tomography is used only when absolutely necessary.

Excretory urography is carried out only after the complete relief of renal colic, since at the height of the seizure not only a stoppage of urine outflow occurs, but also the blood supply to the kidney is disrupted, which, accordingly, leads to the fact that the contrast agent is not excreted by the affected organ. This study is indicated in all cases of pain arising in the urinary tract, with urolithiasis, with the detection of blood impurities in the urine, with injuries. Due to the use of a contrast agent, this method has a number of contraindications:

Excretory urography is contraindicated in the following patients:

• with an allergic reaction to iodine and to a contrast agent;
• patients with myelomatosis;
• with a blood creatinine level above 200 mmol / l.

Laboratory examination of urine

A laboratory study of urine is an extremely important research method for renal colic, since with this ailment, changes in urine always occur ( which, however, may not be present during the attack, but which appear after its relief). A general analysis of urine allows you to determine the amount and type of impurities in the urine, to identify some salts and fragments of stones, to assess the excretory function of the kidneys.

In a laboratory study, an analysis of morning urine is carried out ( which accumulated in the bladder during the night, and the analysis of which allows you to objectively judge the composition of impurities) and daily urine ( which is collected during the day, and the analysis of which allows you to assess the functional ability of the kidneys).

In a laboratory study of urine, the following indicators are assessed:

• the amount of urine;
• the presence of salt impurities;
• urine reaction ( acidic or alkaline);
• the presence of whole erythrocytes or their fragments;
• the presence and number of bacteria;
• the level of cysteine, calcium salts, oxalates, citrates, urates ( stone-forming substances);
• concentration of creatinine ( renal function indicator).

With renal colic and urolithiasis, a high content of calcium salts, oxalates and other stone-forming substances, impurities of blood and pus, a change in the reaction of urine can be found.

It is imperative to conduct an analysis chemical composition calculus ( stone), since further therapeutic tactics depend on its composition.

Renal colic treatment

The goal of treating renal colic is to eliminate pain and spasm of the urinary tract, restore urine flow, and eliminate the root cause of the disease.

First aid for renal colic

Before the arrival of doctors, you can perform a number of procedures and take some medications that will help reduce pain and somewhat improve the general condition. In this case, one should be guided by the principle of least harm, that is, it is necessary to use only those means that will not aggravate or cause complications for the course of the disease. Preference should be given to non-drug methods, as they have the least number of side effects.


In order to alleviate the suffering of renal colic before the arrival of an ambulance, the following measures can be used:

• Hot bath. A hot bath taken before the arrival of the ambulance can help reduce spasm of the smooth muscle of the ureter, which helps to reduce pain and the degree of blockage in the urinary tract.
• Local warmth. If the bathroom is contraindicated or cannot be used, you can apply a hot water bottle or water bottle to the lumbar region or to the abdomen on the affected side.
• Smooth muscle relaxants(antispasmodics). Taking medications that help relax smooth muscles can significantly reduce pain and, in some cases, even cause the stone to pass on its own. For this purpose, the drug No-shpa ( drotaverine) in a total dose of 160 mg ( 4 tablets 40 mg or 2 tablets 80 mg).
• Pain medications. Painkillers can be taken only with left-sided renal colic, since pain on the right side can be caused not only by this ailment, but also by acute appendicitis, cholecystitis, ulcers and other pathologies in which self-administration of painkillers is contraindicated, as it can lubricate clinical picture and make it difficult to diagnose. To relieve pain at home, you can use ibuprofen, paracetamol, baralgin, ketans.

Drug treatment

The main treatment for renal colic should be in a hospital. At the same time, in some cases, there is no need for hospitalization, since the release of the stone and the restoration of the outflow of urine suggest a positive trend. Nevertheless, within one to three days, the patient's condition is monitored and monitored, especially if there is a likelihood of re-development of renal colic or if there are signs of kidney damage.

The following categories of patients are subject to compulsory hospitalization:

• who do not have a positive effect from taking painkillers;
• have a blockage of the urinary tract of the only functioning or transplanted kidney;
• blockage of the urinary tract is combined with signs of an infection of the urinary system, a temperature of more than 38 degrees.

Drug treatment involves the introduction of drugs into the body that can alleviate symptoms and eliminate the pathogenic factor. In this case, preference is given to intramuscular or intravenous injections, since they provide a faster onset of drug action and do not depend on the work of the gastrointestinal tract ( vomiting can significantly reduce the absorption of the drug in the stomach). After stopping an acute attack, it is possible to switch to tablets or rectal suppositories.

For the treatment of renal colic, drugs are used with the following effects:

• pain relievers - to eliminate pain syndrome;
• antispasmodics - to relieve spasm of smooth muscles of the ureter;
• antiemetic drugs - to block reflex vomiting;
• drugs that reduce urine production - to reduce intralocal pressure.

Pain medications

Pharmacological group	Main representatives
Non-steroidal anti-inflammatory drugs	Ketorolac	Intramuscular injections at a dose of 60 mg every 6 to 8 hours for no more than 5 days ( until the pain stops)
	Diclofenac	Intramuscular injections at a dose of 75 - 100 mg per day with a further transition to tablets
Non-narcotic pain relievers	Paracetamol	Inside in a dose of 500 - 1000 mg. It is often used in combination with narcotic pain relievers, as it enhances their effect.
	Baralgin	Intravenous or intramuscular injection of 5 ml every 6 to 8 hours as needed.
Narcotic pain relievers	Tramadol Omnopon Morphine Codeine	The dose is set individually depending on the severity of the pain syndrome ( usually 1 ml of 1% solution). To prevent spasm of smooth muscles, they are prescribed in combination with atropine at a dose of 1 ml of a 0.1% solution.
Local pain relievers	Lidocaine Novocaine	By these means, a local nerve blockade is carried out in order to interrupt the transmission of a pain impulse with the ineffectiveness of other methods of anesthesia.

Antispasmodics

Pharmacological group	Main representatives	Dosage and method of administration, special instructions
Myotropic antispasmodics	Drotaverinum Papaverine	Intramuscularly, 1 - 2 ml to relieve colic.
m-anticholinergics	Hyoscine butyl bromide	Inside or rectally 10 - 20 mg 3 times a day
	Atropine	Intramuscularly 0.25 - 1 mg 2 times a day

Antiemetic drugs

Drugs that reduce urine production

The most rational is the relief of renal colic by intramuscular injection of ketorolac in combination with metoclopramide and any myotropic antispasmodic. If ineffective, you can resort to narcotic pain relievers, which must be combined with atropine. Prescribing other drugs depends on the specific clinical situation. The duration of treatment depends on the duration of renal colic, and can be 1 to 3 days ( in some cases more).

In addition to the listed drugs, drugs from the group of calcium channel blockers ( nifedipine), nitrates ( isosorbide dinitrate), alpha-blockers and methylxanthines, which are able to reduce smooth muscle spasm and eliminate pain, but the effectiveness of which in renal colic is still not well understood.

In some cases, drug treatment also involves the use of drugs that help dissolve stones in the urinary tract. It should be borne in mind that only uric acid stones can be dissolved by medication. To do this, use drugs alkalizing urine.

Drugs used to dissolve uric acid stones

In parallel with this, treatment of the pathology that has become the cause of stone formation is being carried out. For this, various vitamins and minerals can be used, nutritional supplements, drugs that reduce concentration uric acid, diuretics.

Surgery

Surgical treatment allows you to quickly and completely remove the obstacle that caused the blockage of the urinary tract. This method of treatment is used in cases where conservative drug therapy is not effective enough, or when any complications have developed.

Surgical treatment of renal colic is indicated in the following situations:

• complicated urolithiasis;
• hydronephrosis of the kidney ( dropsy of the kidney);
• wrinkling of the kidney;
• ineffectiveness of drug treatment;
• stones over 1 cm in diameter that cannot come out on their own.

Since the main cause of renal colic is urolithiasis, in most cases it becomes necessary to surgically remove stones from the urinary tract. To date, several have been developed effective methods that allow you to break and remove stones with the least injury.

Removal of stones can be done in the following ways:

1. extracorporeal lithotripsy;
2. contact lithotripsy;
3. percutaneous nephrolithotomy;
4. endoscopic stone removal;
5. ureteral stenting;
6. open kidney surgery.

Remote lithotripsy
Remote lithotripsy is modern method destruction of stones using a focused high-energy ultrasound beam, which, acting on the stone, causes its crushing. This method is called remote because it can be used without breaking skin, by applying the device to the skin in the corresponding region ( for better results and muscle relaxation, this procedure is performed under general anesthesia).

This method of breaking stones is used when stones are less than 2 cm in size and are located in the upper or middle part of the pelvis.

Remote lithotripsy is contraindicated in the following situations:

• blood clotting disorders;
• densely spaced stones;
• blockage of the ureter.

Contact lithotripsy
Contact lithotripsy involves the direct effect of a high-energy physical factor ( ultrasound, compressed air, laser) on a stone ( this is achieved by introducing a special tube through the urinary tract into the ureter or by puncturing the skin at the level of the stone). This method allows more accurate and more effective impact on stones, and also provides a parallel extraction of destroyed fragments.

Percutaneous nephrolithotomy
Percutaneous nephrolithotomy is a method of surgical removal of kidney stones in which a small puncture ( about 1 cm) of the skin and a special instrument is inserted through it, with the help of which the stone is removed. This procedure involves constant monitoring of the position of the instrument and stone using fluoroscopic examination.

Endoscopic stone removal
Endoscopic stone removal involves the introduction of a special flexible or rigid instrument equipped with an optical system through the urethra into the ureter. At the same time, due to the ability to visualize and capture the stone, this method allows you to immediately extract it.

Ureteral stenting
Ureteral stenting involves the introduction of a special cylindrical frame endoscopically, which is installed at the site of the narrowing of the ureter or its incision, to prevent stones from getting stuck in the future.

Open kidney surgery
Open kidney surgery is the most traumatic method of removing stones, which this moment practically not used. This surgical intervention can be used with significant damage to the kidney, with its purulent-necrotic changes, as well as with massive stones that are not amenable to lithotripsy.

Preparation for surgical removal of stones involves the following activities:

• Delivery of analyzes. Before undergoing surgery, it is necessary to pass general analysis urine and complete blood count, fluorography, ultrasound and X-ray examination of the kidneys.
• Consultation of a therapist. To exclude possible contraindications and systemic pathologies, it is necessary to consult a therapist.
• Diet. The right diet avoids excess gas and congestion feces in the intestine, which greatly simplifies the intervention. To do this, a few days before the operation, you must give up fermented milk products, fresh vegetables, legumes. No food is allowed on the day of the procedure.

The recovery time after surgery depends on the scope of the operation. For non-invasive and minimally invasive procedures ( lithotripsy, endoscopic and percutaneous stone removal) return to normal activity is possible after 2 - 3 days.

Treatment with folk remedies

TO folk methods treatment of renal colic should be resorted to only when it is not possible to get qualified medical help.

The following remedies can be used to treat renal colic:

• Hot bathroom. As mentioned above, hot water helps to relax the smooth muscles of the ureter. You can add 10 g each ( 2 tablespoons) herbs of creeper, sage leaves, birch leaves, chamomile and linden flowers.
• Medicinal infusion. Six tablespoons of a mixture of birch leaves, steel root, juniper fruits and mint leaves must be poured with 1 liter of boiling water and infused for half an hour. The resulting broth should be consumed warm within an hour.
• Decoction of birch leaves. Eight tablespoons of birch leaves, twigs or buds must be poured with 5 glasses of water and cooked for 20 minutes in a water bath. Consume hot within 1 - 2 hours.

Some medicinal plants can be used to treat and prevent urolithiasis, as they help dissolve and slow down the growth of stones. It is extremely important to select medicinal plants based on the chemical composition of cameos, since the use of an incorrect agent can cause an aggravation of the disease.

The following types of stones can be treated with folk methods:

1. urate ( uric acid) stones;
2. oxalate and phosphate stones.

Urate ( uric acid) stones
For the treatment of uric acid stones, decoctions from mixtures of several plants are used, which are taken for 1.5 - 2 months.

Uric acid stones can be treated with the following decoctions:

• Lingonberry broth. Two tablespoons of a mixture of lingonberry leaves, knotweed herb, parsley root and calamus rhizomes are poured with a glass of boiling water and boiled for 10 minutes in a water bath. It is taken 70 - 100 ml three times a day 20 - 40 minutes before meals.
• Barberry decoction. Two tablespoons of barberry, juniper, shepherd's purse herb, steel root are poured with a glass of boiling water and boiled for a quarter of an hour, after which it is infused for 4 hours. It is consumed warm, 50 ml 4 times a day before meals.
• A decoction of birch leaves. Two tablespoons of birch leaves, black elderberry flowers, flax seeds, parsley herbs, rose hips are placed in 1.5 cups of boiling water and infused for an hour. It is taken 70-100 ml 3 times a day before meals.

Oxalate and phosphate stones
Treatment of oxalate and phosphate stones is carried out over several courses, each of which lasts 2 months, with a break between them in 2 - 3 weeks.

Treatment of oxalate and phosphate stones is carried out by the following methods:

• A decoction of barberry flowers. Two tablespoons of a mixture of barberry flowers, immortelle flowers, lingonberry leaves, black elderberry flowers, sweet clover grass, motherwort herbs are poured with a glass of boiling water, boiled in a water bath for 10 minutes and insisted for 2 hours. Take 50 ml 3 times a day before meals.
• A decoction of the herb budra. Two tablespoons of budra herb, blue cornflower flowers, wintergreen leaves, peppermint leaves are poured with one and a half glasses of boiling water, boiled for 5 minutes and insisted for an hour. Take 50 ml 4 times a day before meals.
• A decoction of immortelle flowers. Two tablespoons of a mixture of immortelle flowers, budra grass, black elderberry flowers, blue cornflower flowers, bearberry leaves, burnet rhizomes are poured with a glass of boiling water, boiled in a water bath for a quarter of an hour and insisted for 4 hours. Drink 50 ml warm 4 times a day before meals.

Prevention of renal colic

What do we have to do?

For the prevention of renal colic it is necessary:

• consume enough vitamins A, D;
• sunbathing ( stimulate the synthesis of vitamin D);
• consume enough calcium;
• consume at least 2 liters of water per day;
• treat pathologies and infections of the urinary system;
• correct congenital metabolic pathologies;
• take walks or other physical exercises.

What should i avoid?

In renal colic and urolithiasis, it is necessary to avoid factors that contribute to the growth of stones and spasm of the ureters. For this purpose, it is recommended to follow a diet with a reduced content of stone-forming substances.

It is necessary to follow a diet for the following types of stones;

• Oxalate stones. It is necessary to reduce the intake of oxalic acid, which is found in lettuce, spinach, sorrel, potatoes, cheese, chocolate, and tea.
• Cysteine ​​stones. Since cysteine ​​stones are formed as a result of a violation of the metabolism of cysteine, it is recommended to limit the consumption of eggs, peanuts, chicken meat, corn, beans.
• Phosphate stones. It is necessary to reduce the consumption of dairy products, cheese, vegetables.
• Uric acid stones. With the formation of uric acid stones, it is necessary to reduce the intake of uric acid, which is contained in meat products, smoked meats, legumes, coffee and chocolate.

Avoid:

• hypothermia;
• drafts;
• systemic and urological infections;
• dehydration;
• lumbar injuries;
• a sedentary lifestyle.

Renal colic is a complex of symptoms that occurs when urine drainage 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, tissues swell, the blood vessels supplying the kidney narrow, and the kidney experiences a lack of oxygen, which only aggravates the situation. At the same time, the person experiences acute pain. It is believed that the pain in renal colic is one of the most severe that a person can experience, and surpasses even childbirth in terms of the intensity of the impact.

How renal colic develops

Acute phase. Renal colic comes on suddenly. If the patient sleeps at this time, he wakes up in pain. If awake, then usually the patient can tell the exact time of the onset of renal colic. The onset of renal colic does not depend on physical activity, but a large amount of fluid drunk the day before, taking diuretics, stress experienced by a person, shaking the road or eating abundant food can contribute to its appearance.

The pain is constant, it can get worse over time. Gradually, the intensity of pain increases, up to the 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 ureteral contractions increases and the obstruction that caused urinary retention moves, the pain may worsen or recur.

Constant phase. When pain reaches its limit, it stays at that level for a long time. Usually this phase, which is very painful for the patient, lasts from one to four hours, but in some (fortunately, rather 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 at any time after the onset of renal colic.

Renal colic symptoms

How to distinguish renal colic from pain caused by other diseases? The most important symptom of renal colic is the nature of the pain. Pain in renal colic always occurs unexpectedly, sharply. First, a person feels an attack of pain in the side, lower back, or in the region 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, it can affect the rectum and the upper legs. Often, the lower the pain, the stronger it is. Patients often report that they experience 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 in renal colic is prolonged, the attack can last from three to eighteen hours.

Depending on the disease that caused renal colic, symptoms accompanying it may vary. As a rule, patients experience frequent urge to urinate, with little or no urine, and cutting pains in the bladder and urethra. The patient's mouth is dry, he is nauseous, 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, the patient feels the urge to defecate. The temperature rises slightly, while a person can be chilled.

Very severe pain in renal colic can lead to the development of painful shock. At the same time, the patient turns pale, the frequency of heart beats decreases, and cold sweat appears on the skin.

After the end of the painful attack, a large volume of urine is released. In this case, due to the presence of blood in the urine, its color may turn reddish. But even if the urine looks the most common, traces of blood can be found under a microscope.

Renal colic in children

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

Renal colicin pregnant women

Often aggravated during pregnancy chronic diseases, and kidney disease is no exception. As a rule, in pregnant women, renal colic develops in the third trimester. The pain usually begins in the lower back and can radiate to the hips and genitals. In the event of renal colic, you should immediately consult a doctor, as there is a risk of premature birth.

Renal colic causes

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

Sometimes renal colic occurs with inflammation of the urinary tract, for example, with hydronephrosis, periureterin, prostatitis, and so on. Renal vein thrombosis, kidney infarction and embolism can also be accompanied by renal colic. And, of course, congenital defects in the genitourinary system caused by impaired development of the fetus 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, up to the death of the kidney, the onset of chronic renal failure and even the death of a person. It is advisable not to take medications at the same time, as they can blur the clinical picture and interfere with the doctor in diagnosing the disease that caused renal colic.

Which doctor to go to for renal colic

First, the patient will be referred to a general practitioner, who, based on the results of the examination, sends the patient to a specialist - a nephrologist or urologist. A nephrologist is consulted in case of renal failure, urolithiasis, polycystic kidney disease, when surgical intervention is not required, but it is enough to do medications... The urologist is a specialist of a more general profile, deals with the genitourinary system entirely and can apply surgical methods of treatment. In some cases, consultation with a gastroenterologist is required (if there is a suspicion of cholecystitis, gastric ulcer or duodenum, gastritis) and a gynecologist (with inflammatory diseases small pelvis, ruptured ovarian cysts and algodismenorrhea).

Diagnosis of diseases that cause renal colic

Making a diagnosis for suspected renal colic is not easy. The medical literature cites data that only one quarter of the total number of patients admitted to the hospital with suspected renal colic suffers from it. In three quarters of cases, the cause of pain is other diseases.

First of all, when making a diagnosis, the doctor interviews the patient, examines his medical history, measures the temperature and blood pressure and conducts a physical examination, that is, palpation (feeling) and percussion (light tapping) of the abdomen, lower back, chest. One of the symptoms of renal colic is soreness in the lumbar region and when tapping on the lower edge of the ribs on the right side. The intensity of pain depends on the stage of development of renal colic - when it is in an acute or constant stage, the sensation is strong, when it subsides, it is weak. And if the attack is over, the patient may not feel pain at all. Palpation will help reveal where the muscles are abdominal cavity tense, which indicates a pathological process in this place. In some cases, it is even possible to grope for an enlarged diseased kidney.

During the examination, the doctor may ask the following questions:

• When exactly did the pain start? (Pain in renal colic can appear suddenly, at any time of the day, and is weakly associated with a person's physical activity.)
• When does the pain go away? Does it appear again, and if so, after how long? (Pain with renal colic may return at any time.)
• Where did the pain begin? Where does it spread? (If the cause of renal colic is mechanical blockage or compression of the ureters, then pain is felt in this place. Subsequently, the pain can go down to the groin, genitals and inner thighs.)
• In what cases does the pain increase and in what cases it decreases? (There are no relieving factors for renal colic, a change in body position does not affect the degree of pain intensity, the pain can worsen with a large number liquid you drink.)
• Is the patient worried about nausea, vomiting? (With renal colic, the patient vomits with the contents of the stomach; vomiting does not bring relief.)
• What is the patient's blood pressure? (Typically, in the case of renal colic, the pressure rises.)
• What is the patient's temperature? (With renal colic, the temperature is usually slightly elevated, between 37 ° and 37.9 °.)
• How is the urination process going? (In renal colic, urination is difficult and painful.)
• Does the patient or his immediate family suffer from urolithiasis? (In most cases renal colic caused by mechanical blockage of the ureters by stones or other formations.)

Diseases that can be confused with renal colic

Acute appendicitis. Most often, renal colic is confused with appendicitis, up to the fact that 40% of patients suffering from kidney or ureteral stones have undergone an appendix removal. The reason for the errors is the proximity of the appendix to the right ureter. One of the main differences between renal colic and appendicitis is the nature of vomiting (with renal colic, it occurs immediately, with appendicitis - after a long time after the onset of the disease) and the position taken by the patient. If patients with appendicitis lie relatively still, then the patient with renal colic constantly changes body position in an attempt to relieve pain.

Hepatic colic. The percentage of errors in this case is less - those suffering from renal colic were treated for hepatic colic in 5% of cases. Renal colic, like hepatic, is characterized by sharp and severe pain that occurs in the same place. However, if in the case of renal colic it spreads down to the groin and genitals, then with hepatic colic it goes up and gives to the chest, scapula and right shoulder. In addition, the doctor can easily establish a connection between diet disorders and an attack of cholecystitis, while in renal colic food does not directly affect its development.

Acute pancreatitis. When the stomach hurts and gives to the back, to the lumbar region (where there is renal colic). As with pancreatitis, so renal colic may be accompanied by flatulence and bloating, as well as nausea and vomiting. However, with pancreatitis, the pressure drops, while with renal colic it is normal.

Intestinal obstruction. It is easy to confuse this condition with renal colic if it is complicated by bloating and flatulence. The main difference between intestinal obstruction and renal colic is the nature of the pain; with the latter it is constant, and with the first it is cramping and depends on the frequency of contractions of the intestinal muscles. The second difference is a high temperature with peritonitis developed as a result of obstruction, while with renal colic the temperature does not exceed 37.9 °.

Abdominal aortic aneurysm... With this disease, the stomach hurts, the pain is radiated in the lumbar region. As well renal colic, aneurysm may be accompanied by bloating, nausea, vomiting. The difference is low, up to the possible development of shock, pressure with aneurysm.

Shingles. Skin rashes characteristic of this viral disease do not appear immediately, which can complicate the diagnosis. With shingles, the pain does not change its location, unlike renal colic, which spreads to the lower trunk.

Lumbosacral sciatica. The nature of pain in sciatica is similar to renal colic - they are strong and sharp. However, the patient does not experience nausea, vomiting, or urinary retention. And with renal colic, the intensity of pain does not depend on the position of the patient's body, as in sciatica.

Inflammation of the appendages. Often, with this gynecological disease, pain radiates to the lower back, due to which it can be confused with hepatic colic. However, unlike the latter, with inflammation of the appendages, a woman feels pain in the region of the sacrum and uterus, which the doctor can easily verify by palpation.

Analyzes and examinations for renal colic

Blood test. As a rule, usually with renal colic, an increased number of leukocytes is not observed in the blood (their presence rather indicates acute inflammatory processes occurring in the body). But the content of urea in the blood serum may increase, when, as a result of blockage of the upper urinary tract and the resulting increase in pressure, urine can penetrate into the blood.

It is also necessary to do a biochemical blood test to assess kidney function, the degree of dehydration, acid-base balance, the amount of calcium and electrolytes. It is also worth checking the level of parathyroid hormones if there is a suspicion of hyperparathyroidism as the cause of hypercalcemia.

Analysis of urine. Blood clots, protein, salts, leukocytes, red blood cells, and epithelium can be found in the urine. If the number of leukocytes is greater than the number of red blood cells, then an infection of the urinary system is possible.

In the overwhelming majority of cases with renal colic, there is blood in the urine, sometimes visible with the naked eye. However, if the ureter of the diseased kidney is tightly blocked, urinalysis may be normal, because in bladder urine comes only from a healthy kidney. The timing of the development of hematuria (blood in the urine) can tell a lot about the cause of renal colic - if blood in the urine appears after an attack of pain, then there is likely a mechanical obstruction in the ureter or pelvis. And if blood appears before the onset of pain, it means that the renal colic is caused by a tumor.

Urine acidity higher than 7.5 may indicate the presence of a bacterial infection and / or struvite stones, while acidity less than 5.5 indicates the possibility of uric acid stones. If there are crystals in the urine, by their type one can guess about the presence and composition of kidney stones.

Daily urine analysis. With a daily urine analysis, all the urine produced by a person within 24 hours (with the exception of the very first, morning portion) is poured into one large container, which is then sent for analysis. This method helps the doctor to determine which metabolic disorder caused the appearance of kidney stones and, as a result, renal colic, to identify whether stones remain after treatment, to determine renal failure or the presence of stones in both ureters.

X-ray of the abdominal cavity and urinary system. On an X-ray of the abdominal cavity, it is possible to determine whether the patient suffers from acute abdominal pathology, intestinal pneumatosis, what pathological changes have occurred in the kidney - if the kidney is sick, it usually looks darker in the picture than healthy. Kidney edema can be identified by the presence of a clear line separating the kidney shadow from the perineal tissue. In the overwhelming majority of cases, the presence of stones can be seen in the picture (the exception is if the stones consist of crystals of uric acid or cystine).

Intravenous urography. During this examination, the patient is placed on an X-ray table, where a radiopaque substance is injected into a vein. Then, after the time specified by the doctor, a series of X-rays are taken. Sometimes the patient is asked to stand up and pictures are taken while standing.

Urography is indispensable for assessing the functioning of the kidneys (this can be seen from the rate of excretion of the contrast agent), determining changes in the structure of the kidney, contours of the calyces and pelvis, patency and function of the ureters. Allows you to determine the presence of nephrolithiasis, stones, hydronephrosis and other diseases that caused renal colic. Works great in tandem with abdominal x-rays and allows you to find which organ system the suspicious darkening belongs to.

True, urography has one big drawback - the contrast agent used can cause allergic reactions and even impaired renal function.

Chromocystoscopy. With chromocystoscopy, the first thing the doctor examines the condition of the mucous membrane of the urinary tract, bladder and ureters using a cytoscope. Then the patient is injected intravenously or intramuscularly with medical indigo carmine. The drug is completely harmless; the only thing he does is stain the urine in blue color... Then the doctor again takes up the cytoscope and assesses how long it takes for the paint to appear in the ureter and bladder, how the colored urine enters the ureter and the general condition of the ureteral orifices. As a rule, if the kidney function is impaired, the appearance of colored urine may be delayed; with a delay of more than 15 minutes, you can talk about serious disorders in the functioning of the kidneys, for example, edema, a stuck stone, or hemorrhage. Although chromocystoscopy does not require special equipment, is easy to perform and is safe for the patient, it is quite painful and is therefore performed under anesthesia.

Ultrasound of the kidneys and bladder... It allows you to determine the condition of the urinary tract, the degree of dilatation of the ureters and renal pelvis, the condition of the renal tissue, and also to find out if the patient has stones in the kidneys and ureters, what size they are and where they are located. True, if the stones are in the middle third of the ureter, it is more difficult to determine their presence using ultrasound due to the pelvic bones that interfere with the view.

Ultrasound of the abdominal cavity and small pelvis. It is carried out if there is a suspicion of an acute abdomen - a complex of symptoms indicating serious diseases of the internal organs of the abdominal cavity. The cause of the condition may be appendicitis, perforation of a stomach ulcer, rupture of the intestine after injury, ectopic pregnancy, and so on. A sharp abdomen is an indication for immediate surgery.

CT scan. If neither X-ray studies nor ultrasound help determine whether there are kidney stones in the patient's body, you can resort to computed tomography of the retroperitoneal space and pelvis. With it, instead of the usual two-dimensional, a three-dimensional image of the patient's body is modeled, and the doctor has the opportunity to examine the affected area of ​​the organ from different angles. The reliability of CT is very high; therefore, CT is often used in difficult cases or when planning surgery.

Urolithiasis as one of the most common causes of renal colic

Kidney stone disease (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, descending from the kidney through the ureters, can cause renal colic in a person. KSD is characterized by high recurrence - about half of the total number of cases is susceptible to re-formation of stones, if it does not deal with the prevention of the disease. More than 70% of cases of kidney colic caused by stones occur in people between 20 and 50 years old, more often in men than in women (ratio 2 to 1). There are several prerequisites for the possible formation of stones.

The most common ones are as follows:

• 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, may stagnate, which leads to its oversaturation with solutes and, as a consequence, the formation of stones.
• Hypercalciuria. The reasons for its occurrence have not yet been studied. It is assumed that this condition may be a consequence of increased absorption of calcium in the blood, an increase in its level in the blood, hypervitaminosis D, hyperparathyroidism, food with a large amount of protein, or systemic acidosis. Hypercalciuria increases urine saturation with calcium salts such as oxalates and phosphates, resulting in the formation of crystals. About 80% of kidney stones contain calcium.
• Elevated levels of uric acid, oxalates, sodium urate, or cystine in the urine. Stones with uric acid salts make up from 5 to 10% of all kidney stones. Often this urine composition is a consequence of a diet high in protein, salts and oxalic acid esters (oxalates), or a genetic disorder that causes increased excretion.
• Infection. It is caused by bacteria that break down urea (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 phosphates of magnesium, ammonium and calcium).
• Insufficient level of citric acid salts (citrates) in the urine. The role of citrates in urine is similar to the role of hydrocarbonates in serum. They lower the acidity of the urine, but also inhibit growth and crystal formation. 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 a person.

Complications of renal colic

As the stone moves out of the calyx-pelvic system, it can injure the ureter, thereby contributing to the formation of strictures in it, block it and cause hydronephrosis and an attack of renal colic, reduce the rate of peristalsis of the ureter, and facilitate the return and stagnation of urine in the kidneys. This, in turn, leads to a decrease in the glomerular filtration rate of urine by the affected kidney and an increase in the load on the healthy one. Complete blockage of the ureter will cause a condition of acute renal failure. If left untreated for 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 urine is surrounded by a fibrous capsule and looks like a tumor). Even more worrying can be caused by an infection in the affected kidney, which as a result 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, and the disease that caused it had no complications. Otherwise, it all depends on the severity of the disease, the age and condition of the patient.

Urgent hospitalization for renal colic

The patient must be urgently sent to the hospital if, despite all efforts, it is not possible to reduce pain in renal colic, the patient has both kidneys affected, or only one is available, when exudate is released (fluid that enters the tissue from the blood vessels during inflammation), hypercalcemic crisis.

Also, urgent treatment is needed if the stone blocking the ureter becomes infected. Such a stone acts as a focus 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.

Renal colic treatment

In the treatment of renal colic, the doctor has two tasks: first, it is required to relieve the pain; secondly, to cure the disease that caused the onset of renal colic, and to normalize the work of the urinary system.

Renal colic pain relievers

• Thermal procedures. You can relieve pain in renal colic by applying a warming compress, warm heating pad to your lower back or abdomen. The patient can take a sitz bath with water above body temperature (up to 39 °) for 10-15 minutes. Attention! If renal colic is accompanied by inflammatory processes in the body, for example, pyelonephritis, then thermal procedures cannot be carried out - they can only worsen the situation.
• Medicines. To reduce spasm of the urinary tract, relieve pain caused by it and resume the flow of urine, the doctor may suggest that the patient take pain relievers - non-steroidal analgesics or, in case of severe pain, opiates. The use of non-steroidal analgesics can kill two birds with one stone. First, they reduce the release of arachidonic acid derivatives, which mediate pain receptors, thus relieving pain from stretching of the walls of the renal capsule. Also, non-steroidal pain medications lead to a decrease in glomerular filtration and a decrease in fluid pressure on the glomerulus. Since patients often cannot take drugs orally due to pain and vomiting, they can be injected intravenously or intramuscularly with pain relievers - for example, Revalgin (metamizole sodium, pitofenone, fenpiverinium bromide), ketorolac, atropine, drotaverine, analgin with platifillin and other. For severe pain, opiates such as morphine sulfate may be used. However, they should be used carefully - in addition to respiratory depression and sedation, the patient may develop dependence. In the future, when his situation improves, the patient can take some drugs on his own, for example, spazdolzin in the form of suppositories, cystenal on sugar under the tongue, cyston tablets, and so on.
• At severe pain the doctor can block the spermatic cord in men or the round ligament of the uterus in women, when a patient lying on the operating table is injected with a syringe with a solution of novocaine into the affected organ. Perirenal blockade, when a solution of novocaine is injected into the perineal tissue, is not recommended for renal colic - it can only additionally injure the kidney and hinder its work. If the pain persists even after the blockade, the patient must be urgently taken to the hospital.
• Ureteral catheterization. If medicines it was not possible to bring relief to the patient, catheterization of the ureter is indicated. If you manage to bring the catheter to the obstruction that clogs the ureter and bypass it, you can immediately remove the accumulated urine, which immediately brings relief to the patient and relieves renal colic. The patient should be given antibiotics to avoid developing an infection.

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 patient's condition. If the cause is a blockage of the ureter, the obstruction can be removed with medication (dissolved or forced to come out on its own). If this is not possible, distance shock wave lithotripsy is used (when shock waves destroy the obstacle, and the remaining small particles leave the urine on their own), contact lithotripsy (destruction of a stone using an endoscope) or percutaneous nephrolithotripsy (when the endoscope is inserted through a tiny incision in the skin ).

If renal colic is caused by kinking of the ureter during the prolapse of the kidney (nephroptosis), in the early stages of the disease, the patient is advised to wear a bandage to prevent the displacement of the kidney, 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.

The stricture (narrowing of the canal) of the ureter can only be corrected by surgery. If the stricture is small, it is removed with endoscopic surgery. If a blood vessel presses on the ureter, the doctor may dissect the ureter during laparoscopic surgery, move the vessel to its posterior surface, and re-stitch the ureter. If the affected areas are so large that their excision is impossible, the affected fragments are replaced with fragments of the patient's own intestinal tissues.

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

Outpatient treatment for renal colic

Young and middle-aged people may be allowed to undergo treatment at home and visit a doctor on their own, if their condition is generally stable and does not cause concern, renal colic is without complications, pain is not severe, and the body's response to the administration of anesthetic drugs is good. And, of course, the patient must be able to regularly travel from home to hospital.

In this case, the patient should follow a home regimen, as necessary, carry out thermal procedures to relieve pain (heating pad, hot bath). Particular attention should be paid to the state of the genitourinary system - to visit the toilet in a timely manner, try to completely empty the bladder, wash your hands with soap and water before and after using the toilet. The patient should from time to time urinate into the container and examine it for the appearance of stones in the urine. Another requirement is to strictly adhere to the diet indicated by the doctor. Usually, for renal colic, treatment table No. 10 or No. 6 is prescribed.

It is not recommended to take several analgesic drugs at the same time at the same time - they can increase side effects each other. If there is anuria (urinary retention), do not try to stimulate urination and drink a diuretic - this can only provoke a new attack of renal colic.

If the patient again feels pain with renal colic, the temperature rises, he is sick, vomits, urination is difficult, and the general situation worsens, an ambulance should be called immediately.

Rehabilitation and prevention of renal colic

After stopping the attack of pain in 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 in the disease and pathological changes in the body. But for any diseases of the genitourinary system, it is recommended to visit a urologist or nephrologist 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 stone reoccurrence, which can cause a new attack of renal colic. One of its main conditions is the consumption of liquid in a volume of at least 2.5 liters 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 additionally limit foods that contain substances that contribute to the formation of this type of kidney stones, such as oxalates (found in apricots, tomatoes, cornmeal, etc.) or purines (beer, legumes, liver, yeast). A patient who has suffered pyelonphritis is advised to refuse to eat fried, fatty, baked foods, dishes with a high content of 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, and also to strengthen the muscle frame with regular exercise. It is usually recommended to follow diet number 7 and individually adjust it for yourself. With nephroptosis, it is important to get enough calories so that the lack of fatty layer does not cause a new prolapse of the kidney and another renal colic.

The topic of today's article is renal colic, symptoms, causes of occurrence and what first aid is needed. Pain in the kidneys (renum torminibus) is one of the acute pathological processes of the urinary system, which is a severe cramping attack.

This happens due to blockage (obstruction) of the upper urinary system, an acute violation of the outflow of urine from the kidneys into the bladder develops.

Symptoms

The clinical picture in men and women has similar manifestations, treatment should be immediate. What is renal colic? An unbearably painful spasm comes on suddenly and is the main symptom.

There is a sharp pain in the lower back, it feels like it is in the entire lower part of the body. At the time of renal colic, a person does not understand exactly where he hurts, the spasm goes to the lower abdomen, gives it to the genitals, suprapubic zone and thighs.

It is impossible to urinate normally, the outflow of urine is extremely heavy, while the urge becomes more frequent. From painful shock, vomiting, gas formation and stool disorder often begin.

The disease can develop in motion, often overtakes when walking, running, riding a bicycle. Less common, but pain can also occur at rest. The spasm is painful and impetuous, it grows and becomes unbearable.

A person does not find a place for himself and a comfortable position in order to somehow alleviate the condition. Some patients point not to the lower back, but to the lower abdomen, groin area, genitals.

This may mean one-sided pathology, with bilateral renal colic, the lower back is very sore. The acute syndrome has a rather long-term character, it weakens only for a while. When urinating after an attack, hematuria, discharge of sand and small stones may appear.

Signs

• Sharp unbearable pain;
• Spasm felt in the lower back (bilateral);
• Painful feelings are localized in the perineum and genitals (one-sided);
• Cold sweat, pale skin;
• Body temperature rises (37.1-37.3 ° C);
• Nausea, often vomiting from pain;
• Rapid heartbeat, high blood pressure;
• The duration of the torment is 2-3 hours;
• Increased gas production (flatulence);
• The desire to drink a lot of fluids;
• Difficulty with urine outflow.

After the end of the attack, the patient can normally go to the toilet. A sediment of sand and small particles of stones is observed in the urine, blood (hematuria) may appear due to trauma to the urethral canal.

Urgently call a doctor, only he will be able to correctly diagnose, since colic is similar to the symptoms of other pathological processes.

Similar signs:

• Appendicitis;
• Pancreatitis;
• Acute inflammation gallbladder(cholecystitis);
• Perforated stomach ulcer;
• Aneurysm (enlargement) of the aorta;
• Herniated disc;
• Intestinal colic.

Why does the attack happen? An agonizing spontaneous spasm arises from the release of the stone. It, in turn, expands (compresses) the urethral canal, its muscles contract, opposing the normal outflow of urine.

Accordingly, the accumulation of urine in the chls of the kidneys increases the pressure, blood flow is disturbed, the parenchyma swells, and excessive stretching of the organ occurs.
This condition requires urgent emergency care, strong analgesic drugs (painful collapse may occur) and often surgical intervention.

Causes

Kidney stones are the main factor. In 60-70% of all cases, there is a martyrdom of stone and sand. Availability inflammatory processes prostate, pyelonephritis and kidney tuberculosis, also accompany the onset of the disease.

Possible pathologies:

• Kink (torsion) of the ureter;
• Tumor formations, heart attack and renal thrombosis;
• Nephrosis, hydronephrosis, nephroptosis;
• Chronic cystitis;
• Abnormalities in the cervix, cysts in the ovaries;
• Pyelonephritis;
• Ectopic pregnancy;
• Pathological processes in the prostate gland (prostatitis, adenoma);
• Congenital anatomical anomalies of the kidneys.

Treatment

The main thing the patient should be provided with urgent care... Call a doctor at home, only he will be able to recognize the main symptoms of the disease.

How can an attack be relieved:

• Provide peace;
• If there is no rise in temperature, fill a hot bath and seat the patient. Or fill containers (heating pad, plastic bottles) and place them under the area where pain is observed;
• To stop the spasm to restore the normal outflow of urine, it is necessary to give an anesthetic: "No-shpa" injections / tablets, "Papaverin", "Spazmalgon", "Drotaverin". If there are solutions for intramuscular injection in the house, it is better to prefer them;
• In severe cases, antispasmodics, which have a narcotic effect, can be prescribed by a doctor;
• Basically, the patient is hospitalized, often an emergency surgery, catheterization, percutaneous puncture nephrostomy (PPS) are performed.

Therapy of renal colic in complicated cases is carried out under the supervision of a doctor in an inpatient department.

The main reasons for hospitalization are:

• Impossible to eliminate acute pain;
• The patient has only 1 kidney;
• A high temperature that lasts for a long time.

What therapy includes:

• Antispasmodics and pain relievers: Ketorolac, Diclofenac, Baralgin, Lidokoin, Atropine. Narcotic action - "Tramadol", "Morphine";
• Medicines that lower the production of urine: "Minirin", "Vasopressin";
• Antiemetic: "Cerucal", "Metoclopramide";
• Surgical treatment is prescribed in severe cases with drug failure.

Indications for surgery

• Acute course of urolithiasis;
• Dropsy of the organ (hydronephrosis);
• Shrunken kidney (nephrosclerosis);
• Lack of result of drug therapy;
• The outflow of urine is impaired due to the obstruction of a large stone.
• The main culprit of the disease is urolithiasis, therefore, basically, the patient is urgently prepared for surgery.

Types of surgical intervention:

• Shock wave distance lithotripsy;
• Enodoscopic;
• Percutaneous nephrolithotripsy;
• Stenting of the urinary tract;
• Striped.

How to help a sick person

Before the doctor arrives, you need to create the necessary conditions to ease the pain syndrome. If you are sure that this condition provoked colic, then put the patient in a hot bath. Give drugs that will quickly relieve the condition before the ambulance arrives.

How to recognize

To diagnose and correctly determine colic and begin the correct conservative treatment, the doctor must first collect the patient's history.

• Palpation diagnostics;
• General analysis of urine and blood;
• X-ray and ultrasound of the kidneys and abdominal organs;
• Intravenous urography;
• MRI, chromocystoscopy.

Consequences

Pyelonephritis, hydronephrosis, pyonephrosis.

Prophylaxis

• The daily rate of fluid should be at least 2.0 liters;
• Proper nutrition, absence of spicy, salty and fatty foods;
• Prevent overheating of the body and hypothermia;
• Take constantly herbal urological preparations;
• Get tested regularly.

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