What causes colic in the kidneys? Renal colic: symptoms and effective treatment

The occurrence of unbearable pain in the lower back, which does not leave the patient alone, forces him to rush about in bed and does not allow him to sit or lie quietly, is almost always a symptom of acute renal colic. This is not a disease, but a symptom of some pathology.

But in any emergency condition, it is initially necessary to eliminate unbearable pain in order to alleviate the patient’s condition. Treatment of the pathology itself is a secondary task.

In order to detect an attack of renal colic, provide adequate assistance and eliminate the cause of the pathology, you need to have reliable information regarding this pathological condition. This is exactly what will be presented in the article.

Fundamentals of the structure of the human urinary system

It is quite difficult to understand the causes of renal colic and the basic principles of its treatment without having data on the process of urination. It all starts with the production of urine by the kidney tissue, then it passes into the pelvis - hollow formations that are located at the outlet of the kidneys. Quite often, stones are located in the pelvis, since their lumen is quite narrow, only a few mm.

The next organ of the urinary system, the ureter, originates from the pelvis. To put it quite simply, it is a hollow tube that communicates with the bladder and kidneys. The ureter is the second “favorite” location for stones. The diameter of the lumen of this organ ranges from 5 to 15 mm, as a result of which blockages of its lumen can form in narrow areas.

After accumulation in bladder The fluid moves further along the urethra and is expelled. This area most often quite rarely becomes the cause emergency.

Reasons

The development of colic can be triggered by various pathologies, but they are united by one common feature - obstruction (blockage) of the urine drainage tract. Each of the pathologies leads to disruption of the outflow of fluid and leads to the development characteristic symptoms. Obstruction of the lumen urinary tract can occur at different levels (in the ureter, pelvis and even in the bladder itself), but the manifestations of the pathology are almost identical.

What pathologies can provoke obstruction? Today the most common diseases are:

Disease	Obstruction mechanism
Urolithiasis	Most often (in 92% of cases) the cause of colic is a stone that clogs the ureter and pelvis. If characteristic symptoms develop, doctors must first rule out the presence of urolithiasis.
Pyelonephritis	Infection in the kidney most often occurs under the influence of microorganisms: influenza bacillus, streptococcus, staphylococcus, E. coli. The inflammatory process quite often occurs with desquamation of the epithelium and fibrin, the formation of pus, which, when passing through the urinary tract, leads to blockage. If there is an excess of these formations, the lumen of the ureter, which in places of narrowing can reach only 5 mm in diameter, can be blocked. It should also be noted that pyelonephritis quite often develops against the background of the formation of kidney stones.
	Mechanical damage to the organs of the excretory system can lead to the development of hematomas and compression of the channels by these formations or the formation of blood clots in the lumens of the channels.
Congenital organ features	This group of causes includes conditions such as abnormal attachment of the ureter to the bladder, incorrect position (dystopia) or prolapse (nephroptosis) of the kidneys. Most often, such features do not cause concern to the patient and quite often go unnoticed throughout life. But under the influence of provoking factors ( infectious process, trauma) the outflow of urine may be disrupted and an acute condition may develop.
The tumor is benign or malignant	Pathological tissue growth can compress the pelvis or ureter in two cases: if the tumor is located next to the structures of the excretory system, or if it grows in these organs.
Kidney tuberculosis	According to modern statistical reports, about 30% of patients in tuberculosis dispensaries have tuberculosis, which is located outside the lungs. Kidney tissue is one of the sites of localization of microorganisms that cause this pathology. Therefore, if colic occurs in a patient with confirmed tuberculosis or the presence of its typical symptoms (low-grade fever, significant weight loss, persistent cough), it is necessary to exclude kidney damage from this pathology.

It is also necessary to highlight one important point - when symptoms of renal colic develop after emergency care, you must first determine the absence/presence of a stone in the lumen of the pelvis or ureter. Only after this can you move on to excluding other diseases.

Symptoms

To diagnose this condition in a patient, only one symptom is enough - characteristic pain. In addition to the pain, two more symptoms may occur: changes in urination and vomiting. These are not necessarily manifestations of colic, but they are quite often observed in patients with such an emergency condition.

Pain

The main complaint for all patients with this pathological condition is the presence of pain in the clinical picture. What kind of pain occurs with renal colic? This is a very intense, cutting pain that patients describe as “unbearable.” Unpleasant sensations haunt you, preventing you from sitting or lying down normally; patients become overexcited and cannot find a place to sit.

The pain is located in the lumbar region and most often radiates to:

into the perineum;

on the front surface of the thigh;

renal colic in women radiates to the vagina and labia;

colic in men spreads to the head of the penis, scrotum, testicle.

This symptom may intensify when palpating the abdomen (in certain places, usually 3-5 cm on either side of the navel) or tapping the lower back. The first sign is not obligatory and develops only when the ureter is damaged.

Dysuria (impaired urination)

Blockage of the urinary tract in most cases leads to the development of this symptom. The patient feels a false urge to urinate, but the amount of urine released is quite small. The process of urination itself is quite unpleasant, since cutting pain occurs in the lower back and perineum. Due to injury to the walls of organs and bleeding (small), urine quite often becomes reddish or pinkish.

Can urine have normal color? Yes, but only when it comes from a healthy kidney. Unfortunately, it is impossible to determine the path of urine outflow at home, so this symptom has additional significance.

Vomit

The development of such a symptom is caused by two mechanisms. The first is severe pain that the brain cannot cope with on its own. As a result of unsuccessful attempts, autonomic disorders develop: general weakness, increased sweating, nausea, vomiting. The second mechanism is the disruption of the solar plexus nerves (at the location of pain), as a result, the functioning of most of the digestive tract is disrupted.

Most often, vomiting is repeated and has nothing to do with ingestion of water or food and develops spontaneously. Taking various sorbents (Smecta, Neosmectin, activated carbon).

Can all symptoms suddenly subside? Yes, quite. The reason for spontaneous improvement is a change in the position of the stone and normalization of urine outflow. In the case of a small stone size (3-5 mm), it may well come out on its own, which will provoke the disappearance of all the above symptoms. Unfortunately, such self-healing is a rather rare phenomenon, and you should not rely on it; it is better to seek specialized help as quickly as possible.

Features of the course of renal colic in children

It is sometimes quite difficult to recognize the presence of this condition in a child. Due to the characteristics and mentality of the nervous system, the symptoms of renal colic most often differ from the generally known symptoms. In children, renal colic in most cases manifests itself as widespread pain throughout the abdomen in combination with impaired urination and the presence of dyspeptic symptoms: constipation/loose stools, vomiting, flatulence, nausea. All these signs lead to difficulties in diagnosis and misdiagnosis.

How to act correctly in such cases? You need to pay attention to the presence of dysuria. If this symptom is combined with abdominal pain, then renal pathologies must be excluded.

Treatment

Help with the development of renal colic should consist of two stages. The first is withdrawal pain attack. Restoring the normal flow of urine and eliminating discomfort is very important, not only to improve the patient’s well-being, but also to preserve the functioning of the kidney. After achieving this goal, you need to move on to the next stage. This stage consists of treating the pathology that led to the development of the emergency condition. This problem is dealt with by highly specialized specialists after the end of the acute period.

First aid

How to behave if renal colic occurs at home? First of all, you should call ambulance. Considering the fact that the team will not be able to arrive instantly, you need to start relieving the condition yourself. To do this, perform the following activities:

Warm the lumbar area. A warm bath (water temperature in which is 38-40 degrees) will give the optimal effect, since it affects not a specific area, but the whole body. An alternative to a bath is a heating pad. But it is worth remembering that if you suspect kidney tuberculosis, heat is contraindicated.

Give the patient a pain reliever. For these purposes, products that have combined action, which combine antispasmodics and NSAIDs. Together, these drugs have a relaxing and anti-inflammatory effect on the organs of the excretory system. Examples of such drugs: “Baralgin”, “Spazmalgon”, “Revalgin”. As an alternative, you can use conventional non-steroidal anti-inflammatory drugs - Citramon, Paracetamol, Ketorolac, Diclofenac.

These actions are performed simultaneously, since it takes about half an hour for the tablets to take effect. Joint effect from first aid measures allows you to slightly improve the patient’s well-being until the arrival of a paramedic or doctor.

How to relieve pain if first aid has no effect? In such cases, the patient needs to perform a blockade - local anesthesia nerve and then into urgently promptly restore the outflow of urine. But such assistance can only be performed in a hospital setting.

Who needs mandatory hospitalization?

The emergency doctor almost always recommends continuing treatment for renal colic in the hospital. Unfortunately, not all patients agree to this offer for personal reasons. This may cause absence adequate therapy and recurrence of the attack in the future.

But there is a group of patients for whom hospitalization is a vital measure. Even after the acute period of pathology has subsided, you should seek help from a hospital if the following conditions exist:

signs of a severe complication appear: pressure drop below 100/70 mmHg. Art., impaired consciousness, increased body temperature above 38 degrees;

when pain occurs on both sides;

the patient has only one kidney.

If patients with the problems listed above do not restore urine within several hours excretory function, the result can be irreversible organ destruction and even death.

Restoring urine flow

The standard algorithm for the presence of renal colic, which is resistant to conventional methods of therapy, is surgical intervention. In modern surgical practice, the intervention is performed through the urethral opening or through making one hole in the skin. The following options for restoring the outflow of urine are also possible:

Percutaneous nephrostomy is most often an emergency treatment method when the surgeon is unable to use endoscopic techniques or they are ineffective. The principle of the method is to introduce drainage into the cavity of the pelvis using a puncture in the skin.

Ureteral stenting - another type of endoscopic intervention is the installation of a special drainage into the pelvis. This method provides a bypass for urine and relieves colic symptoms.

Endoscopic stone removal is the most effective operation, which is performed through the external opening of the urethra. It makes it possible to restore the process of urine outflow in the shortest possible time and with minor trauma.

Only after urine output has been normalized does it make sense to begin treatment for the underlying pathology. If the patient has been hospitalized, the entire necessary diagnostics performed in a hospital. In case outpatient treatment the patient is referred to a local physician.

Complications

If assistance is provided in a timely manner, the prognosis for an emergency condition is favorable. Complications can only arise if treatment is delayed or incorrect. The severity of such conditions can vary, it all depends on the condition of the patient and the duration of stagnation of urine. Among the most common complications are:

• persistent narrowing of the ureter;

  pyelonephritis – inflammation of kidney tissue with suppuration;

  kidney atrophy or nephrosclerosis.

IN clinical practice There are even cases of fatal pathology after attempts at independent long-term treatment folk remedies. All of the above complications (except for pyelonephritis) are quite difficult to treat, but it is much easier to prevent - all you need to do is contact a specialist for help.

Frequently asked questions

How are renal colic and vomiting related?

The reason lies in the structure of the nervous system. The gastrointestinal tract and kidneys receive innervation from one nerve plexus - the celiac trunk or nerve plexus. If there is a disturbance in the outflow of urine, which is always present when a stone passes through the ureter, it becomes irritated solar plexus. Irritation leads to a reflex disturbance of the innervation of the gastrointestinal tract. This leads to nausea and vomiting, and also causes bloating during an attack and constipation.

Why does your bladder always feel like it's full, but when you urinate, very little urine comes out?
This is due to the structural features of the human nervous system. As the stone passes through lower third ureter, irritation of receptors occurs, which provoke a false urge to urinate. This sign can be regarded as positive, since most of the stone’s path has already been passed. However, this should also cause some concern, since the junction of the ureter and bladder is the narrowest in the entire system, so the stone is most likely to get stuck there.

What can trigger the onset of renal colic?

Most often it begins without previous actions, spontaneously, while performing normal activities or at rest. But this does not always happen; some patients had a long train or car ride before the attack occurred. Also among the provoking factors, one should highlight the intake herbal preparations, intended for the treatment of urolithiasis, since they provoke the release of stones. Sometimes the stone begins to move through the excretory system after a strong blow to the back. There are also cases in practice when a patient long time I limited myself in fluids, and then drank a lot of water, which became the cause of the attack.

What is the mechanism of pain development?

If the ureter is blocked by a stone, the process of urine outflow is disrupted. At the same time, new portions continue to be produced and enter the system, but due to blockage of the duct they accumulate in the renal collecting system. Over time, the expansion increases and leads to compression of the vessels feeding the kidney, causing circulatory problems.

It is worth noting that the size of the macrolite cannot affect the severity of pain; even when a stone with a diameter of 1-1.5 mm comes out, a severe attack of renal colic can occur.

Is it possible to confuse this state with symptoms of other diseases?

There are many known pathologies that mimic kidney pain. Among them:

acute pleurisy;

radiculitis;

kidney infarction;

ectopic pregnancy;

torsion of ovarian cyst;

acute appendicitis in adults.

Accordingly, the obvious conclusion suggests itself - to engage self-treatment this emergency condition is strictly prohibited. First you need to accurately determine the cause of the pain and carry out differential diagnosis, and then move on to treatment, which is only possible in a hospital setting.

Can a stone reach the bladder and not come out?

This happens quite rarely, for example, in the presence of prostate adenoma or urethral strictures, when the urethra narrows significantly. Most often, after a stone enters the bladder, it comes out through the urethra, since its diameter is much larger than the diameter of the ureter.

What diagnostic techniques are used for renal colic?

Diagnosis begins with collecting an anamnesis of the pathology (when it began, how it manifested itself, how the nature of the symptoms changed over time). After this, the patient is examined, laboratory tests are carried out, including a biochemical blood test and general analysis urine and blood. Among the instrumental techniques used are urography (excretory or intravenous) and ultrasound.

What does a physical examination of the patient show?

During the examination, pain is detected in the projection of the ureter and in the kidney area. Differential diagnosis with other acute surgical pathologies is also performed.

Why is ultrasound examination needed?

This method is safe, relatively inexpensive and accessible. Using ultrasound, you can see the expansion of the renal pelvis, macrolites and stones in the ureter, and determine the level at which the stone has stopped. But this method is not always highly informative; with increased gas formation and obesity, visualization may be impaired. Diagnosis may also be difficult if certain abnormalities are present. urinary system. Therefore, it is important not to settle on one diagnostic method.

What does excretory urography show and what is it for?

This diagnostic method is the most informative. It is performed in several stages. To begin with, an x-ray is taken, after which they are injected contrast agent. It quickly penetrates into the urine. After this, another photograph is taken, which clearly shows the filling of the ureter and renal pelvis, as well as the level at which the stone is located and its size. A contraindication to this procedure is an allergy to iodine or thyrotoxicosis, since iodine is the coloring substance.

What therapies are used?

If the patient has confirmed renal colic, then treatment is selected based on the origin of this symptom. If the cause is urolithiasis, then there may be three treatment options. The first is lithokinetic therapy. When the results of the examination confirm that this method will not be effective, they move on to extracorporeal lithotripsy or open surgery. The latter is used quite rarely today.

What is the essence of lithokinetic therapy?

If the stone has large size and the likelihood of it coming out on its own is quite high, a number of drugs are prescribed that can speed up this process. Among them are non-steroidal anti-inflammatory drugs (relieve swelling of the ureter and relieve pain), alpha blockers (relax the smooth muscles that line the ureter), antispasmodics (expand the lumen of the ureter).

How long does it take for a stone to pass when using lithokinetic therapy?

This usually takes several days, but if after 2-3 days the stone does not come out on its own, a repeat examination is carried out. Quite often, treatment tactics are changed after this, but if positive dynamics are observed, then conservative treatment continue. If the stone stays at one point for a long time, it is dangerous for the development of fibrosis of the ureter in this place.

What should be understood by extracorporeal lithotripsy?

This method is the “gold standard” in the treatment of urolithiasis. It has been around for three decades and has proven itself to be excellent. Its essence is that with the help of a directed beam mechanical waves influence the calculus and thus lead to its destruction. The procedure is performed under ultrasound or x-ray control. The effectiveness of this procedure is over 95%.

What should you do if the pain has disappeared, but the stone has not come out?

Stones must be removed even when they are not bothering you. If the stone remains in the ureter, but does not block the outflow of urine, trauma to the walls of the ureter continues to occur. The outflow is impaired, and overflow of the renal pelvis leads to the development of hydronephrosis with damage to the renal parenchyma. Therefore, to avoid the development of these complications, the stone should be removed, regardless of the presence of symptoms.

Acute, piercing pain in the lumbar area can dramatically change the usual rhythm of a man’s life. This is how renal colic most often manifests itself. It is important to understand what this condition is and why it occurs, because a man faced with this painful condition needs help.

Characteristics of renal colic

Renal colic is an acute attack of pain caused by pathologies in the urinary system.. Discomfort occurs in the lumbar region on one side, in in rare cases- from both. The pain is dictated by spasm smooth muscles urinary organs.

Colic is the body's response to a disturbance in the outflow of urine from the kidney or a change in blood circulation. Most often, such phenomena are observed in urolithiasis, in which stones that pass from the kidneys damage the walls of the ureter and block (completely or partially) the urinary canal.

Renal colic most often occurs as a result of the movement of stones from the kidney into the ureter and bladder.

How does renal colic manifest?

Renal colic has a number of characteristic symptoms:

• sharp, unbearable pain in the lower back (it can be cramping or constant);
• increased anxiety;
• discomfort radiates to the side, stomach, genitals, leg;
• hematuria (blood in the urine);
• nausea, vomiting;
• increase in temperature;
• increased frequency of urination (if a stone has blocked the ureter, then there is very little urine);
• bloating;
• diarrhea or constipation.

At severe attacks a man may experience pain shock. This condition is accompanied by a weakening of the pulse, profuse sweating, increased blood pressure, pale skin.

The attack can last from 3 to 18 hours, sometimes with short breaks.

Renal colic - video

Causes and development factors

Renal colic is classified as nonspecific symptoms, since it can be triggered by various reasons. Among them:

• Urolithiasis. Stones formed in the kidneys can pass through the urine into the ureter. The movement of a stone along a narrow channel causes an unbearable attack of pain. Some stones have sharp “spikes” and can injure the ureter (which is why blood appears in the urine). And sometimes the stone gets stuck in the canal. This leads to a deterioration in the outflow of urine and expansion of the renal capsule.
• Jades. The appearance of renal colic can be caused by various inflammatory processes occurring in the kidneys (for example,). Such ailments provoke irritation of the bean-shaped organ, as a result of which the latter reacts with intense spasms.
• Kidney tumor. A neoplasm in the structure of an organ may not bother the patient for a long time. The growth of the tumor over time leads to tissue compression. This causes irritation of the kidney, which immediately responds with spasms.
• Kidney tuberculosis. An infectious disease affects the kidney tissue. This leads to organ irritation and spasms.
• . This is a pathology in which kidney prolapse is diagnosed. The mobility of the bean-shaped organ can provoke an attack of severe pain.
• Kidney injuries. Any damage or blows to the lumbar region can lead to severe, bursting pain.
• Anomalies of the urinary system. Severe discomfort may be based on congenital or acquired changes in organs. For example, the outflow of urine becomes significantly more difficult when the urethra or ureter narrows.
• Tumor processes in neighboring organs. The growth of tumors in the prostate gland and rectum can compress the ureter.

Provoking factors

The appearance of renal colic can be caused by the following events:

eating hot, spicy food the day before;

jumping;

lifting weights;

alcohol abuse;

shaking.

Taking an attack of renal colic can provoke spicy food

But sometimes painful discomfort occurs without any previous factors. Some patients note that renal colic appeared at rest, interrupting night sleep.

One summer, when I escaped from all the worries of the city to the dacha, at three o’clock in the morning I was woken up by the persistent ringing of my mobile phone. My neighbor, a 50-year-old man, asked me to come see him immediately. It was clear from his voice that the man was feeling bad. But the state in which I found him simply shocked me. The dream instantly disappeared. The neighbor was pale and vomited periodically. He painfully grabbed his lower back, then his stomach. The sufferer could not even properly explain what was bothering him. I immediately called an ambulance. Meanwhile, the man groaned again from a painful attack. “I need to relieve the spasms,” I thought. There was No-Shpa in my first aid kit. Of course, the pills did not completely relieve the pain, but the neighbor said that it became a little easier.

Diagnosis of pathology

Determining renal colic is not easy, since the pathology is manifested by symptoms that are characteristic of a number of diseases.

Similar symptoms are observed with:

• acute appendicitis;
• volvulus;
• stomach ulcer;
• biliary colic.

Initially, the doctor will examine the patient, palpate the abdomen, and check Pasternatsky’s sign

To give the patient a correct diagnosis, the doctor will initially ask about diet, lifestyle, and existing diseases. Then the doctor will examine the patient, conducting the following tests:

• Palpation of the abdomen. When palpating the anterior abdominal wall with true renal colic, increased pain is noted in the area of ​​the “problem” ureter.
• Pasternatsky's symptom. Light tapping on the lower back in the area of ​​the kidneys causes increased pain.

• Urinalysis. It may contain erythrocytes (red blood cells) and various impurities (sand, pus, blood, fragments of stones, salts).
• Blood test. If inflammation is present, the analysis will show an increase in leukocytes. In addition, kidney pathologies may be indicated elevated levels urea and creatinine.
• Ultrasound examination. An ultrasound procedure can detect stones in the kidneys or ureters. This examination gives an idea of ​​structural changes (thinning of tissue, expansion of the urinary organs).
• X-ray. The event identifies stones and indicates their location. Such a study does not show all types of stones (urate and xanthine on x-rays not visible).
• Excretory urography. This is another X-ray examination. It is carried out after the injection of a contrast agent into a vein. After a while they take pictures. If the ureter is blocked, the contrast agent will not be able to pass further.
• Computed tomography or magnetic resonance imaging (CT or MRI). The most informative and precise methods diagnostics They allow you to examine the kidneys, ureters, and bladder layer by layer and identify the true causes of colic.

Ultrasound of the kidneys allows you to identify stones and determine their location

Treatment methods

If symptoms resembling renal colic appear, you must immediately call an ambulance. The dispatcher must be informed about all the signs observed in the patient.

First aid

To alleviate the condition of a patient experiencing renal colic, you can resort to the following measures:

1. Taking an antispasmodic. To slightly reduce discomfort, it is necessary to relieve renal spasm. For this, the patient is given No-Shpu, Drotaverine, Spazmalgon. If possible, it's better to do it intramuscular injection antispasmodic.
2. Thermal procedures. If we are talking about real renal colic, then heat will bring significant relief. To do this, you can apply a heating pad to your lower back or take a bath.
3. Preparing the container. It is better to empty the bladder into a specially prepared container so as not to miss the release of the stone. It is not the liquid that is valuable, but the stone that comes out. Subsequently, it is submitted for testing of its chemical composition. This will allow you to determine exactly what disorders are occurring in the body and select the optimal treatment methods.

To reduce the pain of renal colic, you can take a hot bath

You can practice thermal procedures only if you are 100% sure of renal colic. If there is even the slightest doubt about the diagnosis, it is better not to resort to this method. The use of heat for appendicitis or peritonitis can lead to serious consequences.

First aid for renal colic - video

Drug therapy

To relieve acute symptoms and restore urodynamics, a patient in a hospital setting may be prescribed the following medications:

• Antispasmodics and analgesics. Such drugs can reduce pain and stop spasms. The following remedies are most often recommended:
  • Baralgin;
  • Platifilin;
  • No-Shpu;
  • Papaverine;
  • Atropine;
  • Promedol.
• Novocaine blockade. If the attack is protracted and cannot be controlled with antispasmodics, then the doctor may resort to a blockade. In this case, the man's spermatic cord is cut off.
• Antimicrobial agents. To stop inflammatory processes, uroseptics or antibiotics may be recommended. Therapy includes the following medications:
  • Nitroxoline;
• Fosfomycin.

Angioprotectors. These medications are prescribed to restore blood microcirculation. The most commonly recommended drugs are:

• Trental;

NSAIDs. Sometimes, for severe pain, nonsteroidal anti-inflammatory drugs may be prescribed. They have analgesic, anti-inflammatory and antipyretic properties. Treatment may include the following:

• Diclofenac;
• Lornoxicam;

Diuretics. They are prescribed only if the stone that comes out does not exceed 4 mm in diameter. In this case, the calculus is quite capable of coming out on its own, without any surgical intervention. To facilitate the exit process, diuretics are prescribed:

Lasix.

Additional medications. For renal colic (if the stone does not exceed 4 mm), medications may be prescribed to help remove stones. The following drugs have these properties:

• Glucagon;
• Nifedepine;
• Progesterone.

Further treatment tactics depend on the patient’s condition and the stage of the pathology. If the attack was stopped, the doctor will prescribe medications that dissolve the remaining stones and prevent their re-formation.

To quickly relieve painful discomfort, doctors may prescribe medications intramuscularly or intravenously.

Such medications include:

• Asparkam - affects oxalates;
• Marelin - helps with phosphate stones;
• Blemaren - effective against urates and oxalates;
• Uralite - affects cystine stones;
• Allopurinol - helps fight urates.
• Cyston - affects mixed types of stones (which can be dissolved).

These medicines it is necessary to take several months so that they provide the necessary dissolution of the stones.

Doctors took the neighbor to the hospital. I couldn’t leave him alone, so I went with him. After all the studies, the doctors concluded - renal colic. The man spent the rest of the night under a drip. Little by little his condition recovered. In the morning, the neighbor was operated on because the stone could not come out on its own. And after 2 days we were already sitting with him at the dacha, drinking aromatic tea and laughing heartily, remembering the events we had experienced.

Medicines - gallery

No-Spa allows you to quickly relieve spasms
Levofloxacin is prescribed to relieve inflammation Pentoxifylline restores blood microcirculation Novocaine is used for novocaine blockades for very severe pain
Furosemide accelerates the outflow of urine, causing the stone to leave the ureter faster Xefocam relieves inflammation and relieves pain Asparkam promotes the breakdown of oxalates Blemaren helps with oxalates and urates Allopurinol dissolves urates

Surgical treatment

Sometimes, with renal colic, it becomes necessary to resort to surgery. The main indications for surgery are following states and pathologies:

• hydronephrosis (or hydrocele of the kidney);
• ineffectiveness of drug therapy;
• complications of urolithiasis (blockage, rupture of the ureter);
• large stones (more than 4 mm in diameter) that cannot pass out on their own.

The tactics of the operation depend on the reasons that provoked renal colic, the condition and individual characteristics patient. The most commonly used methods are:

• External lithotripsy. This operation involves the destruction of kidney stones with ultrasound. In this case, the skin is not damaged. That is why the method is called remote. The device is applied to the body in the required area and the stones are crushed through the skin.
• Contact lithotripsy. In this case, stone crushing occurs during direct contact. A special tube is inserted into the urinary canal and ureter. The device is brought directly to the stone and the stone is split using a laser, compressed air or ultrasound. This technique allows you to act more efficiently and accurately. In addition, during the operation, all destroyed fragments are removed.
• Percutaneous nephrolithotomy. This is surgical removal of the stone. The doctor makes a small puncture of the skin, through which he inserts an instrument into the cavity and carefully removes the stone.
• Endoscopic stone removal. A special tube with an endoscopic system is inserted through the urethra. Such a device is equipped not only with a camera that allows you to visualize stones, but also with special forceps that grasp and remove the stone.
• Ureteral stenting. This operation is used for narrowing of the ureter. Its essence lies in restoring normal lumen in the canal. With the help endoscopic equipment A special cylindrical frame is inserted into a narrow place.
• Open surgery. This is the most traumatic method. Open kidney surgeries are performed only in extreme cases(purulent-necrotic processes, significant damage to the organ, the presence of massive stones that cannot be crushed).

The duration of rehabilitation depends on the volume surgical interventions. On average, recovery takes 2–3 days. If open surgery was performed, rehabilitation may take 5–7 days.

Types of stone removal operations - video

Diet

A man experiencing renal colic is advised to continue following a dietary diet. P The diet is prescribed by the doctor depending on the type of stones.

Basic principles of the diet:

• Frequent appointments. It is recommended to eat food in small portions every 4 hours. It is important not to overeat so as not to overload the body.
• Junk food. Smoked, fried, fatty foods should be excluded from the diet. It is recommended to avoid sweets and flour products.
• Water mode. It is important not to forget to use pure drinking water. Doctors recommend drinking 2.5–3 liters of fluid per day.
• Nutrition for oxalates. With such stones, it is necessary to limit the intake of meat, sorrel, sour fruits and berries. Do not overuse citrus fruits, legumes, beets, and tomatoes.
• Diet for urates. The following products are excluded: chocolate, cheese, nuts, legumes. Salty foods are harmful. It is not recommended to drink strong tea or eat sour berries.
• Nutrition with phosphates. In this case, it is necessary to exclude cottage cheese, potatoes, milk, and fish from the diet. Do not overuse sweet berries and fruits.
• Nutrition for cystine stones. It is recommended to limit the intake of beans, chicken, peanuts, eggs, and corn.

Harmful foods - gallery

Sorrel should not be consumed if you have oxalate problems Nuts will be harmful with urates Cottage cheese is not recommended for phosphates
Corn is prohibited for cystine stones

Folk remedies

If it is not possible to get medical help, then you can use the power of folk recipes. To relieve renal colic, you can use the following remedies:

• Herbal bath. Hot water helps relax the smooth muscles of the ureter, making the attack go away faster. To enhance efficiency medicinal bath, it is recommended to add 10 g of birch, sage, cucumber, linden, and chamomile leaves to the water.
• Birch decoction. You can take leaves, buds or tree branches as raw materials. Birch blank (8 tbsp) is filled with water (5 tbsp). The mixture is boiled for 20 minutes in a water bath. Strain. The finished decoction should be drunk hot over 1–2 hours.
• Healing infusion. It is necessary to combine juniper fruits, birch leaves, mint and steelhead roots in equal proportions. The resulting mixture (6 tbsp) is poured with boiling water (1 l). Infuse the drink for 30 minutes. Then filter. The resulting infusion should be drunk warm within 1 hour.

Forecast and consequences

The prognosis depends on the reasons that provoked renal colic, the patient’s condition, and the timeliness of contacting doctors. Most often, unpleasant discomfort can be relieved with medication or with the help of low-traumatic surgical interventions. In such situations, the patient quickly returns to his normal lifestyle.

In the future, if the cause is hidden in urolithiasis, the person is recommended to adhere to a diet for life that protects against the formation of stones.

The prognosis of the pathology largely depends on the timeliness of visiting doctors

Possible complications

Incorrect treatment or late contact with doctors can lead to the development serious consequences. The most commonly observed complications are:

• Painful shock. Against the background of severe pain, pathologies of the cardiovascular, nervous or respiratory systems may develop.
• Urosepsis. Generalization (distribution throughout the body) urinary infection may be fatal.
• Pyelonephritis. Inflammatory processes can develop in the parenchyma and pelvis of the kidney.
• Bladder pathology. Long-term violation urinary incontinence can lead to the inability to completely empty the bladder in the future.
• Hydronephrosis. Urinary retention provokes pathological expansion pyelocaliceal apparatus of the kidney.
• Pathology of the urethra. The mucous membrane is replaced by scar tissue. This leads to atrophy of the urethra and narrowing of the urethra.
• Nephrosclerosis. The renal parenchyma is gradually replaced connective tissue. This significantly impairs the functioning of the kidney. In the future, this phenomenon leads to organ atrophy.
• Pyonephrosis. Purulent-destructive processes occur inside the kidney.

Prevention

Prevention of renal colic includes several simple rules:

• Water mode. To a healthy person It is necessary to consume at least 2–2.5 liters of water per day. In the summer heat, the amount of liquid increases to 3 liters.
• Proper nutrition. Eliminate from your diet junk food: fatty, fried, salty, smoked dishes. Avoid foods that promote stone formation (soda, coffee, alcohol, sorrel).
• Physical activity. Try to lead an active lifestyle, play sports, go for walks fresh air. At the same time, remember that physical activity must be feasible.
• Dress appropriately for the weather. Avoid hypothermia or overheating. Such extreme conditions serve as a trigger for the development kidney ailments.
To eliminate the risk of developing urolithiasis, you need to drink at least 2 liters of water per day

A painful condition called renal colic can occur as a result of various pathologies of the urinary system. But most often, according to statistics, the source of the problem is urolithiasis. It is impossible to predict in advance what renal colic will lead to. Therefore, it is imperative to consult a doctor. In this case, the patient's chances of healing are significantly increased.

June 15, 2017 Doctor

If a person experiences renal colic, his well-being is seriously affected. A strong pain syndrome appears, sometimes it becomes simply unbearable. How to relieve pain? There are many methods, but it is important to use only those that will not harm and will be aimed at treating the underlying disease.

First aid

If a painful attack develops, you should urgently call an ambulance. Patients, as a rule, are taken to a hospital, and after acute colic is relieved, treatment is carried out at home. Before the medical team arrives, you should try to alleviate the patient’s suffering by relieving pain. First aid is allowed to be provided to a person with left-sided colic and if there is renal pathologies in the anamnesis, when there is no doubt about the diagnosis. If right-sided colic occurs, the diagnosis of inflammation of the appendix should be excluded before taking any medications.

To reduce the severity of the attack, the following measures are allowed:

1. Strengthen your drinking regime.
2. Apply a warm heating pad, a bottle, a bag of sand to the lumbar area (allowed only for repeated colic against the background of the movement of a large stone when the diagnosis has been established). You can also take a hot sitz bath for 10-15 minutes.
3. Give the patient painkillers or antispasmodics to relax smooth muscle, against inflammation and acute pain. Baralgin, Papaverine, No-shpa, Revalgin tablets help well. If there is a health care worker in the family, you can administer the same drugs intramuscularly.
4. In the absence of these drugs, it is allowed to dissolve a Nitroglycerin tablet to relieve the pain of an attack.

What should not be done as first aid measures? It is forbidden to take large doses of analgesics, especially if they do not have the desired effect. Also, you should not heat the lumbar area for a long time; it is better to carry out a short thermal procedure, and then apply dry heat to your back (wrap it with a scarf or handkerchief). Any heating is prohibited if there is an elevated body temperature, because in this case the cause of the disease is the inflammatory process.

Treatment in hospital and at home

There are a number of indications for hospitalization and treatment in a hospital:

• renal colic on both sides;
• a seizure in a child or pregnant woman;
• having only one kidney;
• lack of effect from home therapy;
• old age;
• presence of complications;
• development of colic against the background of pyelonephritis, tumors;
• the appearance of frequent, severe vomiting;
• a sharp increase in body temperature;
• lack of urination.

To relieve an attack, medications are administered in injections, using the above-mentioned antispasmodics, non-narcotic analgesics (a mixture of Novocaine with glucose, Pipolfen, Halidor, Atropine, Diphenhydramine, Diclofenac, Ketonal, Promedol, Platyfillin, Maxigan). You can use non-steroidal anti-inflammatory drugs in tablets and suppositories.

The use of painkillers and medications for smooth muscle spasms is continued until the stone passes and the patient’s condition improves. Antibiotics are prescribed if the cause of colic is an inflammatory process, or it occurs against the background of pyelonephritis. If there is no effect of medications and acute urinary retention, ureteral catheterization is performed. Often you have to do emergency surgery (endoscopic or abdominal methods) to remove the stone.

As the attack subsides and the patient’s health returns to normal, the patient is discharged. A further course of therapy must be carried out at home. It may include the following drugs:

1. Means for optimizing blood circulation in the renal vessels - Pentoxifylline, Trental.
2. Uroantiseptics for relieving inflammation - Furomag, Nitroxoline.
3. Medicines to improve the functioning of the entire urinary system and dissolve stones - Olimetin, Urocholum, Litovit, Uro-Vaxom, Canephron, Cyston.

Folk recipes

Any traditional methods of therapy are allowed to be used only with the approval of a doctor. Renal colic can accompany serious diseases of the urinary system, which are dangerous and sometimes lead to death. It is important not to delay treatment in a hospital, relying on folk remedies.

Stories from our readers

“I was able to cure my KIDNEYS with the help of simple remedy, which I learned about from an article by a UROLOGIST with 24 years of experience, Pushkar D.Yu...”

The following recipes exist:

1. Brew a glass of horsetail herb in 2 liters of boiling water, leave for 2 hours. Strain and pour into a warm bath. Take a bath for 15 minutes.
2. You need to eat watermelons (300-700 g per day), as this product has a diuretic effect and relieves attacks of colic - removes stones from the ureter.
3. For acute pain, take cabbage leaf, crush it in your hands. Wrap the area of ​​the affected kidney with a warm cloth and leave until the condition improves.
4. Brew a tablespoon of birch buds with 300 ml of boiling water, leave for an hour. Drink 100 ml of infusion three times a day. It is advisable to use this therapy over a course of 7-10 days.

Prevention of pathology

To no longer suffer from painful symptoms, you should follow your doctor’s recommendations for treating all kidney diseases. It is necessary to find out the reasons for the appearance of kidney stones and influence them with the help of drugs and diet. In the absence of contraindications, the water regime should be increased. Salt in the diet should not exceed the amount allowed by the doctor. Also, as a preventive measure, you should give up smoking and alcohol, lead an active lifestyle, and avoid hypothermia and the appearance of foci of infection in the body. In this case, the risk of exacerbation of kidney disease will be minimal.

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Renal colic is acute, unbearable, paroxysmal pain in the lumbar spine caused by impaired outflow of urine from the kidney. At the same time, the blood supply to the organ is reduced, nutrients and oxygen are not supplied. The attack occurs unexpectedly, at any time of the day or night.

Pathogenesis

Difficulty in the process of urination leads to overflow of the pelvis and calyces with urine, increased pressure, and as a result, blood circulation in the kidney is impaired.

Renal colic is an attack with serious impairment of organ functionality and injuries to the surfaces of the ureter.

The consequences of the condition pose a danger to a woman’s life.

Ureteral stones are usually small in size – up to 5 mm in diameter. They leave the body freely. Stones with a diameter of 5–10 mm pass away unexpectedly, and large ones (from 1 cm) are removed only in a hospital, for example, surgically. If the stone does not pass within 2 months, it will not pass away on its own.

Symptoms in women

Unpleasant painful sensations occur suddenly, without any preliminary signs. Renal colic has one main symptom is pain. There is no relief when changing body position. It is characterized by severity, contractions, and often occurs at night, during sleep.

In some patients with a low sensitivity threshold, vomiting and nausea are added. Pregnant women experience increased tone uterus, which poses a danger to the fetus. Spasms are transmitted to nearby organs. The intestines create false urges to empty. Hematuria (blood in the urine) and dysuria (impaired urination) are present. Elevated temperature occurs against the background inflammation and infection.

The nature of pain in renal colic is determined by location and radiation (the area to which the spasms extend).

This depends on the degree of inflammation of the urinary tract. If there are stones in the pelvis, the source of pain is located above in the lumbar region, sensations are distributed to the rectum and abdomen.

When obstruction is present in the ureter, the source of pain is located in the lower back on the side of inflammation, pain can be felt in the groin, urethra, and external genitalia. In most patients the stomach and genitals hurt more than the kidneys. Parts of stones, blood and salts are found in the urine.

Only a doctor should diagnose an attack of renal colic so as not to confuse it with other causes of pain. These include running, sports games, excessive physical activity, drinking plenty of fluids, and using diuretics.

During an attack, additional symptoms appear:

• constant urge to urinate;
• drying of the oral mucosa;
• cutting, drawing pain in the rectum;
• chills;
• disruption of the heart;
• loose stool.

If these symptoms occur, you should immediately consult a doctor.

Causes of colic

There are many reasons that provoke the disease. Colic in the kidneys occur when urine flow is impaired.

An attack of renal colic is caused by the following pathological phenomena:

• contraction of the ureteral muscles;
• increased pressure in the pelvis;
• kidney ischemia;
• swelling of the parenchyma;
• stretching of the fibrous capsule;
• venous stasis;
• glucocorticoid therapy;
• blockage by blood clots;
• detached part of the tumor.

Urinary retention occurs due to concomitant diseases:

• pyelonephritis;
• kidney tuberculosis;
• allergic diseases;
• infectious diseases;
• urolithiasis. Stones in the pelvis move, become pinched in the ureter (usually in the lower section);
• compression of the ureter under the influence of tumors of neighboring organs;
• kidney injuries;
• bladder tumor.

Kinking of the ureter cause the following reasons:

• dystopia (improper arrangement of organs);
• nephroptosis;
• ureteral stricture (narrowed lumen);
• inflammatory process;
• heart attack;
• embolism;
• renal vein thrombosis;
• congenital anomalies;
• renal tumors;
• prostate cancer;
• prostate gland;
• venous phlebostenosis.

Duration of renal colic

How long does renal colic last?

Attack always lasts for a long period, in most cases from 12 to 24 hours.

Often the pain is observed for several days in a row, sometimes there are moments of weakening, but the unpleasant sensations do not disappear completely.

They increase progressively, the character is constant with intensified attacks.

The pain goes through three phases. Sometimes renal colic lasts less (from 3 hours). Highlight:

• Acute period. The attack appears at night or in the morning. During the day, it most often proceeds slowly. The peak intensity occurs in the 1st–2nd and 5th–6th hours of the attack.
• Constant period. The phase begins after 1–4 hours and lasts up to 12 hours. It is then that patients are given help and a course of treatment is prescribed.
• Fading period. For several hours, patients feel relief from pain relief.

Female characteristics

A condition associated with blockage of the urinary tract sometimes indicates surgical pathologies of the female reproductive system, which is not related to kidney function. This could be one of the following factors:

• fallopian tube ruptures;
• ovarian apoplexy;
• ovarian cyst when damaged.

Gynecological diseases are accompanied by additional symptoms:

• hypotension (low blood pressure);
• increased heart rate;
• pale skin;
• dizziness;
• cold sweat

Syndrome in pregnant women

Quite often during pregnancy, stones appear in the urinary system.

Symptoms of renal colic: pain with contractions, hematuria, passage of stones.

It is important for a pregnant woman to monitor her health in order to detect and diagnose the disease in time, stop pain, and prevent consequences.

The hardest thing complication – premature birth.

Painful spasms are relieved with antispasmodics. Manipulations are carried out under the supervision of a doctor.

Important! When providing first aid for renal colic, thermal procedures are strictly prohibited.

Complications

If the difficulty in the outflow of urine continues throughout the day, while the outflow of urine is blocked completely, this leads to to irreversible kidney damage. So, a stone that is located in the ureter manifests symptoms a month after its appearance.

Complications of renal colic:

• deterioration of kidney function;
• (purulent inflammation);
• difficulty in patency of the ureter;
• development of pyelonephritis.

Timely recognition of renal colic and qualified medical care will ensure the preservation of the kidney.

First aid

At home, first aid measures must be taken. The woman herself, under the influence of the syndrome, does not always know how to help herself. What to do in this state?

First aid consists of several stages:

1. Warming compress. The heating pad is applied to the area where painful spasms are felt (abdomen or back).
2. Sitz bath. Effective relief occurs when acceptance hot bath , the temperature of which is 40 degrees.
3. Taking medications. Relief from spasm is achieved by taking No-shpa. Painkillers will temporarily reduce the pain threshold (Ketanov, Ibuprofen). An attack cannot be treated with painkillers; they do not affect the course of the disease, so simply stopping the symptoms is not worth it.

Repeated attacks of renal colic require mandatory hospitalization.

Doctor's help

After examining the patient, the doctor confirms the diagnosis and begins to treat renal colic. Tests and studies are required, on the basis of which assistance is provided. When treating kidneys, several indications must be observed:

1. Creating complete peace for the patient.
2. Measures to relieve spasms, stabilize the outflow of urine (thermal physiotherapy).
3. Administration of painkillers.
4. The use of medications that reduce spasms and antiemetics.
5. Taking drugs of the narcotic group (morphine, promedol, tramadol).
6. Carrying out a blockade according to Lorin-Epstein implies administration of novocaine solution in the area of ​​the peripheral part of the round ligament of the uterus. The procedure is performed for pelvic stones.
7. The use of intrapelvic blockade according to Shkolnikov is indicated for stones in the upper ureter.
8. Physiotherapy (vibration procedure, ultrasound therapy, exposure to Bernard's diadynamic currents) is carried out to facilitate the removal of small stones.

If these methods do not lead to positive results, treatment at home is prohibited, and urgent hospitalization of the patient is necessary.

Treatment of kidney diseases in a hospital includes the following procedures:

• ureteral catheterization;
• puncture nephrostomy;
• surgical intervention.

Diet for renal colic

Women should limit their intake of fats and carbohydrates. Eliminate heavy foods from your diet(fried, salty, spices, chocolate, coffee).

• light chicken broth;
• boiled sea fish;
• fermented milk products;
• fresh fruits, especially pears and apricots;
• cranberry juice;
• rosehip decoction.

Proper nutrition reduces the likelihood of recurrence of renal colic by 75%.

Preventive measures help avoid an attack. Key recommendations include:

• Drink enough water(at least 2-2.5 l). The liquid dilutes the urine.
• Eat a balanced diet
• Limit salt intake.
• Avoid overheating the kidneys.
• Drink urological drinks (herbs, berries).

Attention! Long-term blockades negatively affect the functionality of the kidneys, leading to hydronephrosis and complete loss of the kidney.

Video: symptoms and treatment of renal colic

Conclusion

Having identified the symptoms of renal colic, you should immediately provide first aid, contact medical institution for further therapy. Timely diagnosis and compliance with preventive measures will save the woman not only her kidney, but also her life.

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

Separately, it is necessary to mention that after an attack of renal colic, when the occlusion of the ureter is eliminated, the pain syndrome becomes less pronounced ( the pain becomes aching) and stands out relatively large number urine ( 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. Occasionally, individual small stones may be passed along with the urine, a process sometimes called “birth of a stone.” In this case, the passage of a stone through the urethra can be accompanied by significant pain.

Diagnosis of renal colic

In most cases, diagnosing renal colic is not difficult for a competent specialist. This disease is assumed during a conversation with a doctor ( which in some cases is sufficient for diagnosis and initiation of treatment), and is confirmed by inspection and a series of instrumental and laboratory tests.

It is necessary to understand that the process of diagnosing renal colic has 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 for more rational treatment and prevent ( or postpone) repeated exacerbations. Differential diagnosis is necessary in order not to confuse this pathology with others that have a similar clinical picture ( acute appendicitis, hepatic or intestinal colic, perforated ulcer, thrombosis of mesenteric vessels, adnexitis, pancreatitis), and prevent incorrect and untimely treatment.


Due to the pronounced pain syndrome that forms the basis of the clinical picture of renal colic, people with this disease are forced to seek medical help. During acute attack renal colic, adequate assistance can be provided by a doctor of almost any specialty. However, as mentioned above, due to the need to differentiate this disease from others dangerous pathologies, first of all you 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 its causes is a urologist. Exactly to to this specialist should be contacted first if renal colic is suspected.

If renal colic occurs, it makes sense to call an ambulance, as this will allow earlier treatment aimed at eliminating pain and spasm, and will also speed up the process of transportation to the hospital. In addition, the emergency doctor makes a preliminary diagnosis and sends the patient to the department where he will receive the most qualified care.

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

• survey;
• clinical examination;
• ultrasound examination;
• X-ray methods research;
• laboratory urine test.

Survey

Correctly collected data on the disease 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 concomitant pathologies.

During the survey, the following facts are revealed:

• Characteristics of pain. Pain is a subjective indicator that cannot be quantified and the assessment of which is based only on the patient's verbal description. To diagnose renal colic, the time of onset of pain and its nature are important ( sharp, dull, aching, constant, paroxysmal), the place of its distribution, changes in its intensity when changing body position and when taking painkillers.
• Nausea, vomiting. Nausea is also a subjective sensation, which the doctor can only learn about from the patient’s words. The doctor must be informed when the nausea began, whether it is associated with food intake, and whether it gets worse in some situations. It is also necessary to report episodes of vomiting, if any, their connection with food intake, and changes in general condition after vomiting.
• Chills, increased body temperature. You should tell your doctor if you develop chills and elevated temperature body ( 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, or whether blood or pus is discharged along with the urine.
• Presence of attacks of renal colic in the past. The doctor must find out whether this is the first time this attack has occurred or whether there have been previous episodes of renal colic.
• Presence of diagnosed urolithiasis. It is necessary to inform your doctor about the presence of urolithiasis ( if there is one now, or was in the past).
• Diseases of the kidneys and urinary tract. The presence of any pathologies of the kidneys or urinary tract increases the likelihood of renal colic.
• Surgeries or injuries to the urinary system or lumbar region. It is necessary to inform your doctor about previous surgeries and injuries to the lumbar region. In some cases, about other surgical interventions, as this suggests possible factors risk, as well as speed up differential diagnosis ( removal of the appendix in the past excludes acute appendicitis in the present).
• Allergic reactions. It is imperative to inform your doctor if you have any allergic reactions.

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

• diet;
• infectious diseases ( both systemic and urinary tract organs);
• intestinal diseases;
• bone diseases;
• place of residence ( to determine climatic conditions);
• place of work ( to clarify working conditions and the presence of harmful factors);
• 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 menstrual period ( to exclude ectopic pregnancy), chair characteristics ( to exclude intestinal obstruction), social conditions, bad habits and much more.

Clinical examination

Clinical examination for renal colic provides a fairly small amount of information, but, nevertheless, in combination with a well-conducted interview, it suggests renal colic or its cause.

During a clinical examination, it is necessary to undress so that the doctor has the opportunity to assess the general and local condition of the patient. To assess the condition of the kidneys, percussion can be performed - lightly tapping the back with a hand in the area of ​​the twelfth rib. The occurrence of pain during this procedure ( Pasternatsky's symptom) indicates damage to the kidney on 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 are rarely palpated during this procedure ( sometimes only their lower pole), however, if it was possible to palpate them completely, then this indicates either their descent or a significant increase in their size.

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

Ultrasound examination

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


Since the quality obtained with ultrasound examination images are influenced by many factors ( intestinal gases, subcutaneous fatty tissue, fluid in the bladder) it is recommended to prepare in advance for this procedure. To do this, you should exclude milk, potatoes, cabbage from your diet a few days before the examination. raw vegetables and fruits, as well as take activated carbon or other drugs that reduce gas formation. Drinking regime there is no need to limit.

Ultrasound examination without preliminary preparation may be less sensitive, but in in case of emergency when necessary urgent diagnostics, the information received is quite sufficient.

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 allows you to visualize the following changes:

• expansion of the pyelocaliceal system;
• an increase in kidney size by more than 20 mm compared to another kidney;
• dense formations in the pelvis, ureters ( stones);
• changes in the structure of the kidney itself ( previous pathologies);
• swelling of the kidney tissue;
• purulent foci in the kidney;
• changes in hemodynamics in the renal vessels.

X-ray research methods

Radiation diagnostics 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. Overview shot 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 blood circulation in the kidneys, evaluate the filtration function and concentration of urine, and also monitor the excretion of urine through the collecting system and ureters. The presence of an obstacle leads to a delay 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.
• Computed tomography. CT scans produce images that help evaluate 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 plain X-ray image, during an attack of acute renal colic, it is the one that is taken first, since in the vast majority of cases the stones formed in the kidneys are X-ray positive.

Computed tomography is indicated for suspected urolithiasis caused by urate ( uric acid) and coral-shaped ( more often – post-infectious nature) stones. In addition, tomography allows you to diagnose stones that could not be detected by other methods. However, due to more high price Computed tomography is used only when absolutely necessary.

Excretory urography is carried out only after complete relief of renal colic, since at the height of the attack not only the outflow of urine stops, 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, urolithiasis, detection of blood in the urine, and 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 allergic reaction for iodine and contrast agent;
• patients with myelomatosis;
• with a blood creatinine level above 200 mmol/l.

Laboratory urine test

Laboratory testing of urine is an extremely important method of investigation for renal colic, since this disease urine changes always occur ( which, however, may not be present during the attack, but which appear after its relief). A general urine test allows you to determine the amount and type of impurities in the urine, identify some salts and stone fragments, and evaluate the excretory function of the kidneys.

Laboratory testing involves analyzing morning urine ( which accumulated in the bladder during the night, and the analysis of which allows us 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 capacity of the kidneys).

Laboratory testing of urine evaluates the following indicators:

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

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

It is extremely important to analyze the chemical composition of the stone ( stone), since further therapeutic tactics depend on its composition.

Treatment of renal colic

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 doctors arrive, you can perform a number of procedures and take some medications that will help reduce pain and improve your health somewhat. 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 in the course of the disease. Preference should be given non-drug methods, as they have the fewest side effects.


In order to alleviate suffering from renal colic, the following measures can be used before the ambulance arrives:

• Hot bath. A hot bath, taken before the ambulance arrives, can reduce spasm of the smooth muscles of the ureter, which helps reduce pain and the degree of blockage of the urinary tract.
• Local heat. If the bath is contraindicated or cannot be used, you can apply a hot heating pad or a bottle of water to the lumbar region or 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 is used ( drotaverine) in a total dose of 160 mg ( 4 tablets of 40 mg or 2 tablets of 80 mg).
• Painkillers. Painkillers can only be taken for left-sided renal colic, since pain is associated with right side can be caused not only by this disease, but also by acute appendicitis, cholecystitis, ulcers and other pathologies in which self-administration of painkillers is contraindicated, as it can blur the clinical picture and complicate diagnosis. To relieve pain at home, you can use ibuprofen, paracetamol, baralgin, ketanov.

Drug treatment

Primary treatment for renal colic should be done in a hospital. Moreover, in some cases there is no need for hospitalization, since the passage of the stone and restoration of the outflow of urine indicate positive dynamics. However, the patient’s condition is monitored and monitored for one to three days, especially if there is a possibility of recurrent renal colic or if there are signs of kidney damage.

The following categories of patients are subject to mandatory hospitalization:

• who do not have a positive effect from taking painkillers;
• who have a blockage of the urinary tract due to a single functioning or transplanted kidney;
• blockage of the urinary tract is combined with signs of 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 action of the drug and do not depend on the functioning of the gastrointestinal tract ( vomiting may significantly reduce absorption of the drug from the stomach). After stopping an acute attack, it is possible to switch to tablets or rectal suppositories.

To treat renal colic, drugs with the following effects are used:

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

Painkillers

Pharmacological group	Main representatives
Nonsteroidal 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 further transition to tablets
Non-narcotic painkillers	Paracetamol	Orally at a dose of 500–1000 mg. It is often used in combination with narcotic painkillers, as it enhances their effect.
	Baralgin	Intravenously or intramuscularly, 5 ml every 6 to 8 hours as needed.
Narcotic painkillers	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 spasms of smooth muscles, they are prescribed in combination with atropine at a dose of 1 ml of a 0.1% solution.
Local painkillers	Lidocaine Novocaine	These means carry out local nerve blockade in order to interrupt the transmission of pain impulses when other methods of pain relief are ineffective.

Antispasmodics

Pharmacological group	Main representatives	Dosage and method of administration, special instructions
Myotropic antispasmodics	Drotaverine Papaverine	Intramuscularly, 1–2 ml until colic is relieved.
m-anticholinergics	Hyoscine butyl bromide	Orally 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 option is to relieve renal colic with intramuscular injection ketorolac in combination with metoclopramide and any myotropic antispasmodic. If ineffective, you can resort to narcotic painkillers, which must be combined with atropine. The prescription of other drugs depends on the specific clinical situation. The duration of treatment depends on the duration of renal colic, and can range from 1 to 3 days ( in some cases more).

In addition to the listed drugs, drugs from the group of blockers can be used calcium channels (nifedipine), nitrates ( isosorbide dinitrate), alpha-blockers and methylxanthines, which can reduce smooth muscle spasm and eliminate pain, but whose effectiveness in renal colic has not yet been sufficiently studied.

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. For this purpose, drugs that alkalize urine are used.

Drugs used to dissolve uric acid stones

In parallel with this, treatment of the pathology that caused stone formation is provided. For this, various vitamins and minerals, nutritional supplements, drugs that reduce the concentration of uric acid, and diuretics can be used.

Surgical treatment

Surgical treatment allows you to quickly and completely eliminate the obstruction that caused the blockage of the urinary tract. This treatment method 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 ( hydrocele of the kidneys);
• kidney shrinkage;
• inefficiency drug treatment;
• stones more than 1 cm in diameter that cannot pass on their own.

Since the main cause of renal colic is urolithiasis, in most cases there is a need for surgical removal of stones from the urinary tract. To date, several effective methods have been developed that allow you to break and remove stones with the least amount of trauma.

Stones can be removed in the following ways:

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

External lithotripsy
External lithotripsy is modern method destruction of stones using a focused high-energy ultrasound beam, which, when exposed to the stone, causes its crushing. This method is called remote because it can be used without disturbing skin, by applying the device to the skin in the appropriate region ( For best result and muscle relaxation, this procedure is performed under general anesthesia).

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

External lithotripsy is contraindicated in the following situations:

• bleeding disorders;
• densely spaced stones;
• blockage of the ureter.

Contact lithotripsy
Contact lithotripsy involves direct exposure to a high-energy physical factor ( ultrasound, compressed air, laser) on the stone ( this is achieved by inserting a special tube through the urinary canal into the ureter or by puncturing the skin at the level of the stone). This method allows for more accurate and efficient manipulation of stones, and also ensures parallel extraction of destroyed fragments.

Percutaneous nephrolithotomy
Percutaneous nephrolithotomy is a method of surgical removal of kidney stones in which a small puncture is made ( about 1 cm) 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 the stone using fluoroscopic examination.

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

Ureteral stenting
Ureteral stenting involves the endoscopic introduction of a special cylindrical frame, which is installed at the site of 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 is currently practically not used. This surgical intervention can be used in case of significant damage to the kidney, with purulent-necrotic changes, as well as in case of massive stones that are not amenable to lithotripsy.

Preparation for surgical removal of stones involves the following activities:

• Taking tests. Before surgical intervention, it is necessary to pass a general urine test and a general blood test, do fluorography, and conduct an ultrasound and x-ray examination of the kidneys.
• Consultation with a therapist. To exclude possible contraindications And systemic pathologies it is necessary to consult a therapist.
• Diet. A proper diet allows you to avoid excess gas formation and accumulation of feces in the intestines, which greatly simplifies the intervention. To do this, a few days before the operation you need to give up fermented milk products, fresh vegetables, legumes. On the day of the procedure, eating is prohibited.

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

Treatment with folk remedies

Traditional methods of treating renal colic should be resorted to only when it is not possible to obtain qualified medical care.

The following medications can be used to treat renal colic:

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

Some medicinal plants can be used for the treatment and prevention of 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 the wrong remedy can cause aggravation of the disease.

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

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

Urate ( uric acid) stones
To treat urate stones, decoctions of mixtures of several plants are used, which are taken for 1.5 - 2 months.

Urate stones can be treated with the following decoctions:

• Lingonberry decoction. Two tablespoons of a mixture of lingonberry leaves, knotweed, parsley root and calamus rhizome are poured with a glass of boiling water and boiled for 10 minutes in a water bath. Drink 70-100 ml three times a day 20-40 minutes before meals.
• Barberry decoction. Two tablespoons of the fruits of barberry, juniper, shepherd's purse grass, and steelberry root are poured with a glass of boiling water and boiled for a quarter of an hour, then left for 4 hours. Use 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, rose hips are placed in 1.5 cups of boiling water and left for an hour. Take 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 of 2 - 3 weeks.

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

• Decoction of barberry flowers. Two tablespoons of a mixture of barberry flowers, immortelle flowers, lingonberry leaves, black elderberry flowers, sweet clover herb, motherwort herb are poured with a glass of boiling water, boiled in a water bath for 10 minutes and left for 2 hours. Take 50 ml 3 times a day before meals.
• Decoction of budra herb. 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 left for an hour. Take 50 ml 4 times a day before meals.
• 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 left for 4 hours. Take 50 ml warm 4 times a day before meals.

Prevention of renal colic

What should I do?

To prevent renal colic you need to:

• use sufficient quantity vitamins A, D;
• sunbathing ( stimulate vitamin D synthesis);
• consume enough calcium;
• drink at least 2 liters of water per day;
• treat pathologies and infections of the urinary system;
• adjust congenital pathologies metabolism;
• take walks or other physical exercise.

What should you avoid?

In case of 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 cysteine ​​metabolism, it is recommended to limit the consumption of eggs, peanuts, chicken meat, corn, and beans.
• Phosphate stones. It is necessary to reduce the consumption of dairy products, cheese, and vegetables.
• Uric acid stones. When uric acid stones form, it is necessary to reduce the intake of uric acid, which is contained in meat products, smoked meats, legumes, coffee and chocolate.

Must be avoided:

• hypothermia;
• drafts;
• systemic and urological infections;
• dehydration;
• lumbar region injuries;
• sedentary image life.