Renal colic: causes, symptoms, treatment and prevention. Renal colic - causes, symptoms, diagnosis, treatment, diet

An attack of acute pain resulting from a sudden violation of the outflow of urine occurs in such conditions:

• Urolithiasis disease;
• Omission of the kidney with an inflection of the ureter;
• Kidney injury;
• Tuberculosis of the renal pelvis;
• Pyelonephritis: acute and chronic - in the acute stage;
• Tumor of the kidney.

Renal colic most often occurs when urolithiasis. The risk factors for its development are the following reasons:

• Suffering from urolithiasis of blood relatives;
• Loss of fluid in the body - a state of exicosis;
• Prolonged febrile state, accompanied by elevated body temperature;
• Kidney disease: pyelonephritis, urinary tract infections leading to scarring that narrows the urinary tract;
• Errors in nutrition, taking hardly soluble foods or medicines.

renal colic in clinical practice occurs in 10% of men and 5% of emergency cases in women. Urolithiasis affects people of working age: from 30 to 50 years. In half of the cases, an attack of acute pain recurs after a while, that is, it has a tendency to relapse.

Renal colic, mechanism of development

When the lumen is blocked by a calculus or compression of the ureter from the outside, the passage of urine is disturbed. It continues to be produced, but since the outflow is disturbed, it accumulates in the renal pelvis, causing swelling of the kidney tissues. Receptors signal the stretching of the pelvicalyceal system, the alarm signal enters spinal cord, forming a focus of receptor overvoltage. After some time, pain impulses reach the cerebral cortex.

Renal colic, symptoms

Regardless of the source of occurrence, the main symptom of any colic is a sharp (stabbing) pain. When the abdominal organs are affected, pain occurs in the abdomen and lower back. When renal colic develops, its symptoms are somewhat different from pain in colic of a different localization.

The nature of the pain in the defeat of the urinary tract:

• Suddenness, constancy, cramping;
• Sufficiently long duration: from several minutes to 12 hours;
• The inability to take a position of the body in which the pain subsides.

Renal colic in children is accompanied by the appearance of pain in the navel, which is accompanied by an increase in body temperature up to 37.5 ° C, vomiting and severe fear.

When there is a blockage of the ureter in pregnant women, the cramping character imitates the onset of labor, however, the uterus is in normal tone, but dysuric manifestations are noted: increased urination with a small amount of urine.

Depending on the place of blockage of the ureter, renal colic gives different reflected pain, the symptoms of which indicate the anatomical localization of urinary tract obstruction. The "traveling" stone stops at the narrowing of the ureter, and in each case there is a different prevalence of pain:

• The mouth in the region of the renal pelvis - in the middle region of the abdominal cavity;
• Cross with the arteries of the iliac region - the outer surface of the thigh and inguinal region;
• The mouth of the bladder - the lower abdomen;
• Inside the wall of the bladder is the urethra.

The resulting renal colic symptoms have not only affecting the urinary system, but the whole body as a whole. Obstruction of the ureter is often accompanied by the following manifestations:

• Vomit;
• Paralytic ileus;
• Dizziness, fainting;
• Increased blood pressure;
• Rare pulse.

Contrary to popular belief, hematuria (the presence of blood in the urine) appears only when renal colic resolves. That is, the stone leaves the urinary tract. As a rule, the size of the calculus less than 0.5 cm contributes to the independent separation along with the outgoing urine. Stones are found in the urine in the form of fine sand, the separation of which is also accompanied by acute pain.

In cases where renal colic develops on the background of cancer, hematuria occurs immediately, simultaneously with back pain.

Renal colic, treatment

When clarifying the diagnosis using an ultrasound examination on a portable sensor, patients are subject to emergency hospitalization in the following cases:

• Lack of effect from therapeutic measures;
• Development of complications;
• Solitary kidney or simultaneous involvement of two ureters.

If renal colic occurs for the first time, treatment is carried out in a hospital. This is necessary to determine the cause of kidney pathology. When the introduction of antispasmodics and painkillers has a positive effect, the patient is not hospitalized, but the data about him is transferred to the clinic for outpatient monitoring.

Since promedol and its analogues cause strong relaxation, as a result of which the stone moves uncontrollably along the ureter, as a result of which the volume of the operation increases several times, today renal colic is not stopped by narcotic drugs!

For the purpose of removing acute pain drugs are introduced that block the main mediators of pain - prostaglandins. For this, non-narcotic analgesics are used.

Renal colic, emergency care

To provide self-help, but not self-treatment, some recommendations have been developed that help to endure the pain before the ambulance arrives. With pains of low intensity and a well-known diagnosis of urolithiasis, taking a hot bath helps. In the absence of conditions for taking a bath, when renal colic begins, urgent care limited to taking an antispasmodic (no-shpy) and applying a hot heating pad to the lower back.

It is advisable to collect urine for analysis before the doctor arrives. Timely laboratory testing is so important that it can often save a patient's life.

Video from YouTube on the topic of the article:

Usually, by the time the first attack of renal colic occurs, a person already has an established diagnosis of urolithiasis or other urological disease. However, sometimes stones in the kidney do not make themselves felt for years. And an unexpected attack, provoked by the passage of a stone, a person takes for something else. After all, there are quite a few similar conditions. Therefore, it would be useful for all people to know the mechanism of development of renal colic, its symptoms and features.

What is renal colic

Renal colic - unexpected sharp pain in the ureter or in the kidney, which has a paroxysmal character, a special irradiation and is accompanied by digestive and urinary disorders. Its origin comes down to four main factors:

• stretching of the kidney cavity and its outer capsular membrane;
• irritation or compression of intrarenal nerve receptors;
• backflow of urine from the ureter into the pelvis (reflux);
• increased intrarenal pressure due to obstruction of the outflow of fluid from the kidney.

Renal colic is a consequence of acute blockage of the ureter. It is usually caused by the passage of a stone or accumulation of salt crystals through it. Colic is both right- and left-sided, while its course is the same and differs only in the direction of the spread of pain. Sometimes this phenomenon occurs simultaneously on both sides.

The cause of an attack in almost 90% of cases is urolithiasis. However acute disorder the patency of the ureter does not necessarily imply its presence. Blockage can occur during the movement of purulent or blood clot, as well as a fragment of a decomposing tumor. Sometimes attacks of colic are caused by a kink in the ureter when the kidney is lowered (nephroptosis).

Blockage of the ureter by a stone is the most common, but not the only, cause of renal colic.

Complete obstruction (overlap) occurs not only as a result of a mechanical obstruction. It can also be functional in nature: at the level of blockage, a spasm of the ureter appears. Since the contracted wall of the latter periodically relaxes, some of its permeability still remains.

Urine seeps between foreign body and the inner surface of the ureter, as a result, the pain decreases somewhat, but with the resumption of the spasm, it becomes aggravated again. With a complete blockage of the outflow of urine, it takes on a constant cramping character and is accompanied by chaotic and unproductive pelvic contractions. This causes hydronephrotic expansion of the kidney cavity and overstretching of the outer shell of the organ.

As the foreign body moves down, another factor in the origin of the pain attack is added: direct irritation of the nerve endings of the ureter. When the calculus is localized in the upper or middle third of this hollow organ, discomfort spreads along its course. But as soon as the foreign object reaches the point of intersection of the ureteral tube with the common iliac artery, the pain begins to radiate to the suprapubic area and thigh.

The mechanism of pain irradiation is determined by the anatomical relationship between the common iliac artery and the ureter. These hollow organs are in close proximity to each other and are in close contact. Therefore, irritation of the nerve receptors of the ureter is transmitted to the mentioned blood vessel, and then to its continuation - the femoral (external) iliac artery on the side of the lesion. The irradiation of pain down the abdomen and into the suprapubic zone is due to the transmission of its impulses to the branches of the internal iliac artery.

Irradiation of pain: the difference between men and women

Throughout its length, except for the pelvic segment, the ureter in women is no different from that in men, except perhaps for a slightly shorter length. For both, the inner diameter of the lumen of this tube in different parts is from 6 to 15 mm.

Interestingly, the walls of the ureter have very good extensibility. Due to its elasticity, the organ is able to expand up to 80 mm in the lumen. This property helps a person survive renal colic and acute urinary retention associated with blockage of the ureter.

But in the pelvic part of women and men, the ureter has some anatomical features. In the former, it goes around the uterus from the side, passing along its wide ligament, is located behind the ovary and ends in bladder at the level of the upper third of the vagina.

In the representatives of the stronger sex, the ureter goes forward and outward from the vas deferens. Having rounded the latter from the side, it flows into the bladder at a point located just above the upper edge of the seminal vesicle.

Until the stone has reached the pelvic region, the manifestations of renal colic in patients of both sexes are the same. With further downward movement, the calculus reaches the point of intersection of the ureter:

• in women - with a round ligament of the uterus;
• in men - with the vas deferens.

At this site of the "journey" of a foreign body along the urinary tract, the nature of the irradiation of pain becomes different. In women, it now radiates to the large genital lips, and in patients of the opposite sex, to the scrotum and testicle on the side of the lesion.

If the calculus managed to get into the bladder, then it begins to irritate the nerve receptors of the tissues in contact with the neck of this organ. Consequently, pain sensations now spread in the direction of the urethra: in females, they radiate to the vestibule of the vagina, and in male patients, to the head of the penis.

Features of renal colic in infants

Unfortunately, kidney disease sometimes does not spare even the smallest children. Babies in their first year of life can also have an attack of colic. They have some special features. Diagnosis is much more difficult, since the child, by virtue of his early age can't pinpoint exactly where it hurts.

In infants, acute blockage of the lumen of the urinary tract with a stone is characterized by sudden anxiety. Pain in infants is concentrated in the navel. The child is actively moving, rushing about in the crib, kicking his legs, screaming piercingly.

Parents should be aware that the following signs indicate renal colic in a baby:

• severe bloating and tension in the abdomen;
• sharp pain when touched - when trying to stroke the stomach, the child cries out;
• breast rejection;
• repeated vomiting;
• prolonged absence of stool;
• increase in body temperature up to 38–39 o C.

Physicians explain the increase in body temperature (hyperthermia) by the occurrence of the reflux of urine from the renal pelvis into the general circulation - pyelovenous reflux. This fact has an irritating effect on the body's thermoregulatory center, which is the cause of hyperthermia. Having arisen in this way, it does not depend on the presence of bacteria in the urine.

In the case of penetration into the urinary tract of pathogens, the result of long-term renal colic in infants can be apostematous nephritis. This is a particularly dangerous species. acute inflammation kidneys, characterized by numerous abscesses (apostemes) in the parenchyma of the organ. Fortunately, in babies, the attack usually ends within 15 to 20 minutes.

Often the clinical picture of renal colic in infants is taken by parents for intestinal obstruction. To differentiate these two conditions, it is necessary to give the baby an enema. With renal colic, a large amount of feces is released along with the flushing fluid. With obstruction or volvulus of the intestines, on the contrary, it is not possible to obtain bowel movements with the help of an enema, but it is possible to secrete scarlet blood from the anus.

With surgical pathologies of the abdominal cavity, such as appendicitis or cholecystitis, the child tries to lie still on his back.

Video: why there is pain with renal colic

Typical symptoms in adults and the nature of pain

An attack of renal colic most often begins during a significant physical activity or human movement. Often the impetus for the discharge of the calculus is given by driving on a rough road, shaking. But an attack can occur without a provoking factor - at rest or even in a dream.

Passage of stones

The duration of the attack, depending on the speed of movement and the size of the foreign body, varies from 20 minutes to several days. If the stone is small and smooth, then the pain attack ends within 2-3 hours. The patient is most concerned about small acute-angled calculi: they are very mobile, move for a long time and easily injure the mucous membranes of the urinary tract.

Often, several small stones come out with urine during an attack of colic. After the departure of the first of them, temporary relief occurs, but with the beginning of the movement of the next, the pain resumes.

In some patients, stones are excreted painlessly.

Hematuria

With renal colic, an admixture of blood is observed in urine, sometimes quite intense; often with the naked eye, blood clots are visible in it. In a laboratory study of urine sediment, even if it visually has a normal color, an increased number of erythrocytes (red blood cells) is detected.

For renal colic due to urolithiasis, it is typical that the pain precedes the onset of bleeding and indicates the beginning of the migration of the calculus. With other urological pathologies, everything happens the other way around. First, a person develops hematuria, and later an attack of colic, provoked by a blockage of the ureter with a large blood or purulent thrombus, joins it.

Gastrointestinal, general and dysuric disorders

Due to the fact that during colic there is irritation not only of the renal, but also of the celiac plexus, the typical symptoms of this condition are nausea and vomiting. There is bloating due to a delay in the passage of gases and stools.

The patient becomes pale, covered with a cold sweat. He has a fever, often accompanied by headache, weakness, dryness of the oral mucosa.

If a foreign body stops in the final (vesical) segment of the ureter, a person experiences frequent, painful and unproductive urge to urinate. During an attack of renal colic, sometimes there is even an acute retention of urine caused by blockage of solid foreign bodies in the urinary tract.

The nature of the pain

A large calculus, densely “settled” in the kidney, as a rule, does not interfere with the outflow of urine and does not cause renal colic. For the onset of an attack, incomplete occlusion of the ureter with a small stone or an accumulation of crystals of urinary salts is sufficient.

A painful attack with renal colic overtakes a person suddenly. Unbearable pain makes him rush about and change his position every minute in the hope of finding a position in which it will become smaller. Most often, the patient lies on his side with his knees pulled up to his stomach. Such restless behavior of the patient is explained by the fact that each new change of position for a short time brings some relief.

Sometimes a person during renal colic takes the most sophisticated, bizarre body positions. People say about such behavior "climbs the wall."

By the nature of the spread of pain, it is possible to approximately determine on which segment of the urinary tract the stone is currently located. The lower the foreign body moves along the ureter, the more intense the pain radiates to the leg on the side of the lesion and to the genitals.

While the obstruction is in the pelvis or in the upper segment of the ureter, the pain is localized in the lumbar region. But as soon as the stone descends into the lower segment of the urinary tract, it moves to the iliac or inguinal zone of the body.

Video: symptoms of renal colic

Diagnostics

Classical renal colic has a typical clinical picture, and its recognition for an experienced urologist is not particularly difficult. There are several methods to eliminate all doubts about the diagnosis.

Palpation and percussion

Healthy kidneys usually do not react in any way to their probing. With typical colic, two-handed palpation of the lumbar region intensifies the attack. During pressure on the abdominal wall in the direction of the affected ureter, a sharp pain is noted. With a quick flip of a person to the other side, an increase in painful sensations is also observed.

The classic manifestation of renal colic is Pasternatsky's symptom, which is revealed in this way: the examiner puts one hand on the patient's kidney area with the palm down, and gently but surely taps it with the edge of the second. If at the same time the pain intensifies, then Pasternatsky's symptom is considered positive. If the patient does not notice discomfort, the sign is negative. Often after determining positive symptom Pasternatsky in a patient with renal colic, blood appears in the urine.

Laboratory research

Abnormalities in the results of laboratory analyzes of body fluids cannot be considered as a reliable sign of renal colic. Characteristic for her is only an increased number of erythrocytes (red blood cells) in the urine - hematuria.

Typical laboratory symptoms inflammatory process (increased ESR, shift leukocyte formula to the left, leukocytosis in the blood) are indirect and can be both with renal colic and with other acute diseases of the abdominal organs.

Changes in urine characteristic of urolithiasis during an attack of renal colic may not be observed due to complete blockage of the affected ureter by a foreign body.

Instrumental Methods

The decisive role in the recognition of renal colic belongs to urgently performed x-ray studies.

Plain radiography

First of all, the patient performs a simple survey radiography of the abdominal organs. Already at this stage, a shadow of a foreign body in the urinary tract is often detected, which makes it possible to make a diagnosis with almost 100% accuracy. However, the possibility of stones and blood clots in the veins or any inclusions in the intestines visible on the x-ray should be taken into account.

The presence of colic is indicated by an important radiographic sign - an area of ​​rarefaction surrounding the shadow of an enlarged kidney. It is the result of edema of the perirenal tissue.

Excretory urography

Second stage instrumental diagnostics is excretory urography. In this case, the patient is administered intravenously with a radiopaque solution, which is excreted by the kidneys with urine and makes the urinary tract visible on the urograms. The method also allows you to distinguish the outlines of the stone in the pictures.

According to the results of excretory urography, the degree of impaired renal function is assessed. At the height of an attack of colic on the affected side, the organ may not work at all. However, there is an increase in the shadow of the diseased kidney due to the fact that its parenchyma is saturated with a contrast solution. This phenomenon suggests that the function of this organ is preserved and can be restored.

The urographic method reveals the secretion of a contrast agent by both kidneys. During an attack of colic on the affected side, there is an expansion of the pelvis and the upper part of the ureter. The lumen of the latter is filled with a contrast solution to the level of overlap with a calculus.

Differential Diagnosis

There are many conditions that mimic renal colic. Therefore, it is necessary to know their main distinguishing features. For example, perforated stomach ulcer, appendicitis, acute diseases gallbladder and liver have to be distinguished from right-sided renal colic, pancreatitis - from the left, and inflammation of the female organs reproductive system- with bilateral.

Unlike renal colic, other diseases with an "acute abdomen" clinic are distinguished by the patient's desire for peace, because the slightest movement increases pain. As they say, a person "lies in a layer" at the same time. And no matter how strong the pain in renal colic, general state the patient suffers little. During it, there are no manifestations of general intoxication, typical for diffuse peritonitis.

Table: differential signs of renal colic and similar diseases

Prognosis and complications

If the stones are small and smooth (up to 6 mm in diameter), then in the vast majority of cases during renal colic they come out on their own, and there is no need for surgical aids. The prognosis is worse for large stones with spike-like growths.

In case of protracted, not relieved by medication pain attacks, to restore the outflow of urine in a hospital, one has to resort to catheterization of the urinary tract. In the most severe cases, with the ineffectiveness of all conservative measures, the patient is waiting for surgical intervention: dissection of the anterior abdominal wall and ureter with removal of the stone. Fortunately, this need is extremely rare.

The following factors directly affect the possibility of developing complications:

• the underlying disease that caused renal colic;
• the degree of overlap of the lumen of the ureter;
• the general condition of the patient's body and his age;
• timeliness and correctness of the provided pre-medical and medical care.

Bilateral obstruction of the ureters by stones can cause a complete stop of urination and anuria, lasting up to several days. The same complication can also occur when the outflow of urine is obstructed by a foreign body on only one side, accompanied by a reflex or nerve spasm of the second ureter. The condition of anuria is extremely life-threatening and requires emergency medical care.

The most common severe consequences of a prolonged attack of renal colic include:

• development of acute purulent pyelonephritis;
• uremic coma;
• septic shock;
• hydronephrosis and decreased kidney function;
• formation of cicatricial narrowing of the ureter.

After the attack is over, the patient feels better, but for some time he may experience a dull sensation of discomfort in the lumbar region.

Prevention

Prevention of the occurrence of renal colic consists in the exclusion of all possible risk factors, primarily urolithiasis. To avoid relapse, a person will have to stubborn, often long-term treatment of the underlying pathology that caused the attack.

• drinking plenty of fluids (2.5 liters of fluid per day) to keep urine in a diluted state;
• balanced diet;
• limiting salt intake;
• the use of urological herbal preparations, lingonberry and cranberry fruit drinks.

Video: how to prevent attacks of renal colic

The topic of anatomy, physiology and human health is interesting, loved and well studied by me since childhood. In my work I use information from the medical literature written by professors. I have my own extensive experience in the treatment and care of patients.

The combination of symptoms, accompanied by the appearance of severe pain in the lower back, is called renal colic. Renal colic and acute urinary retention are interrelated. Many believe that this disease is associated with kidney problems, but in reality it is a complication of other acute and chronic processes in the body and is associated with acute blockage of the urinary tract ( purulent discharge, stones, blood clots, etc.) This disease affects adults over the age of 40, the elderly, as well as those whose work is associated with lifting weights, hypothermia. Children do not suffer from this disease very often.

Causes of colic

Main Factors

• urolithiasis (ICD);
• omission of the kidney;
• violation of the formation of the genitourinary system;
• glomerulo- and pyelonephritis;
• malignant neoplasms of the kidneys;
• inflection of the urinary canal;
• trauma;
• neoplasms (adenomas, uterus, rectum).

Related factors

• dehydration of the body (with chronic intestinal disorders);
• taking large doses of diuretics;
• work associated with frequent lifting of weight;
• hypothermia;

Most often, ICD can cause renal colic. Kidney stones that form when this disease, clog the urinary canal, disrupting the outflow of urine. In this case, a lot of fluid is collected, which overstretches the pelvis of the kidneys, disrupts blood circulation in the organ and causes an attack of acute renal pain.

Symptoms in men and women

Symptoms of colic in men and women are:

• pain;
• violation of urination;
• increased body temperature;
• dyspeptic disorders.

Women suffer from this disease less often than men, but the symptoms of renal colic in men are the same. The leading symptom of renal colic is the presence of cramping pain. First, spasms are localized in the lumbar region. Then the pain expands and radiates to the groin, genitals (in men - to the penis and scrotum, in women - to the labia), upper thigh. Renal colic is characterized by a protracted course. During this time, the pain is localized in the lower torso. A manifestation of this disease is the urge to urinate frequently, but due to blockage of the urethra, it is difficult. Vomiting in renal colic is observed when the pain advances to the upper abdomen. Dyspeptic disorders appear (colitis, constipation, nausea, vomiting, patients feel fever). The main feature that makes them more painful is that patients often change their body position.

Pregnancy and colic

During pregnancy, existing diseases are exacerbated and new diseases appear. At this time, the protective functions of the body decrease, immunity decreases, and stones form in the kidneys. Then there will be renal colic syndrome. Pregnant women often notice the appearance of renal colic on the right. Signs of renal colic in pregnant women are no different from the symptoms of ordinary colic, but proceed more rapidly. Right-sided renal colic during pregnancy is accompanied by severe pain, problems with urination, and the appearance of fever. There is a spasm of the smooth muscles of the uterus and is accompanied by an increase in tone, which leads to the threat of miscarriage.

Symptoms of colic in children

Very rarely, renal colic occurs in children. Pain may appear during the school period at the age of 10-14 years. The main causes of the disease are:

• heredity;
• congenital defects in the development of the urinary system;
• environmental problems (the presence of a high level of Ca in drinking water);
• increased physical activity sports;
• hypothermia.

Pain in this disease in children is not as acute as in adults. Therefore, they cannot show exactly where it hurts, pointing first to the stomach, then to the lower back. More often there is renal colic on the right (affects right kidney). In such cases, it is necessary to consult a doctor to establish an accurate diagnosis. These manifestations are treated in a hospital.

Complications of renal colic

The occurrence of complications depends on the timeliness and quality of the medical care provided, physical condition, the factors that caused the disease. These include:

• acute purulent pyelonephritis;
• septic shock;
• kidney failure;
• the appearance of narrowing of the ureter.

With untimely medical care, small pustules form in the kidneys, the contents of which spread throughout the body, causing severe intoxication. Patients have chills, fever that does not go astray, dry mouth, pain when urinating. Septic shock may develop later. An increase in toxins in the blood can provoke it. Patients present with fever, confusion, convulsions, weak pulse, and hypotension. This is very dangerous complication renal colic, in which the risk of death is high.

With a sharp hypotension (the cause of occurrence is shock), renal failure appears. Such a manifestation of a complication occurs due to the fact that blood circulation is disturbed in the affected kidney, as a result of which the pressure in the kidney rises and it does not perform the function of filtering and forming urine, metabolism is disturbed, which leads to a failure of all systems of the human body. This disease can cause narrowing of the ureter. Normally, it is an elastic hollow tube that helps move urine from the kidney to the bladder. But after the illness, constrictions form in it, which prevent the free outflow of fluid through the ureter, causing stagnation.

Diagnosis of renal colic

• Examination by a urologist.
• General analysis of urine and blood.
• Blood chemistry.
• Ultrasound and CT (shows the condition of the kidney tissue and the presence of a stone).
• Excretory urography - the introduction of intravenous contrast helps to find out where the stone is (be sure to do a contrast tolerance test).
• Chromocystoscopy - detects the absence of contrast release through a blocked ureter.

The task of the urologist is to collect an anamnesis. The description of the patient's symptoms makes it possible to determine the severity of the disease. Objective examination: - from the side where the stone is located, there will be pain. Percussion will show pronounced pain sensations. They are either left or right (left-sided or right colic). AT laboratory tests revealed blood in the urine, salts of urates, oxalates. With renal colic, an increase in leukocytes and protein is observed in the urine. In blood tests - increased ESR, leukocytes. A change in the amount of creatinine and urea indicates impaired renal function, and an increase in calcium and a decrease in magnesium, phosphorus confirms a metabolic disorder and the risk of cameos.

Differential Diagnosis

This disease has many common symptoms with other diseases of the abdominal cavity, therefore, to confirm this pathology, differential diagnosis is needed:

• With appendicitis, the onset of the disease is the same as with renal colic - a sudden onset of pain in the lower abdomen, but with appendicitis it decreases if the patient lies down. The nature of the pain in appendicitis is local, and the pain in renal colic is radiating to other organs.
An attack of renal colic occurs suddenly and lasts up to 15 hours. First aid is provided after the establishment of colic or the appearance of a second attack. If renal colic occurs and the patient is at home at this time, then you need to put a heating pad or something warm on the place where it hurts the most. They also use antispasmodics, which are in the home medicine cabinet ("Baralgin", "Papaverine"). Each urination must be controlled - collect urine in any vessel and check for the presence of a stone in it. Further treatment of renal colic is carried out in a hospital, the duration of which depends on the severity of the disease. Help with renal colic is to relieve spastic pain:
• "No-shpa" is an antispasmodic, which is injected intravenously with 2 ml of a 2% solution.
• "Baralgin" is an anesthetic, anti-inflammatory substance that must be administered intravenously to children from 15 years of age and adults.
• "Diclofenac sodium" - reduces inflammation and swelling in the area of ​​​​inflammation. Enter parenterally 75 mg.

Renal colic is pathological condition, the main symptom of which is lower back pain with a transition to the inguinal region. Other symptoms that complement the discomfort are related to the activity of the cardiovascular and digestive system. Colic does not occur with full kidney health. This factor suggests the need for extensive diagnostics and finding out the cause of the attack. With primary discomfort in the lumbar region, you need to visit a therapist. The specialist will conduct an examination and refer you to narrow-profile doctors, depending on the alleged cause of colic.

Renal colic is a collective term that means pain in the lumbar region. Thanks to characteristics, the condition can be quickly diagnosed. Relief of a pain attack is only a part of medical care: then a full treatment follows (elimination of the underlying pathology). The duration of therapy depends on the severity and nature of the disease, which served as the root cause of temporary disability. A back pain attack is a spasm caused by urinary obstruction inflammatory process, destruction of the parenchyma, or a combination of these processes.

Risk factors

Common factors predisposing to the development of renal colic and the underlying causes of this condition:

1. Climatic, environmental conditions (humid environment)
2. Hypovitaminosis (in particular, deficiency of vitamins A and E in the body)
3. Poor quality food, drinking contaminated water
4. Dehydration
5. hypothermia

Additional risk factors: exhausting work, hereditary predisposition, alcoholism, long-term medication.

The reasons

Colic occurs as a result of inflammatory-infectious or other processes associated with impaired blood supply to the kidney. The attack also causes a violation of the anatomy, a shift in the location of the main organ of the urinary system. Various elements (tumors, polyps, blood clots, stones) that create an obstacle to the outflow of urine from the kidney also cause colic attacks. The goal of treatment is to eliminate diseases that block the ability to move urine through the departments of the system.

A pathology in which stony deposits with a different chemical composition form inside the pelvis. Depending on it, stones (their second name) are classified into oxalates, urates, phosphates, xanthines, struvites, cystines. The term "renal colic" is most often used in relation to urolithiasis - when I describe clinical manifestations states.

Reasons for the development of pathology:

• hereditary predisposition
• abuse of sour, spicy, salty foods
• metabolic disease
• sedentary lifestyle
• drinking contaminated water

For a long time, the patient is unaware of the presence of stones inside the renal pelvis. After a bumpy ride, physical activity or other factors, the position of the calculus changes. Since the conglomerate has uneven edges, it scratches the tissues of the organ, which is accompanied by pain. Discomfort is caused by the process of stone mobility inside the pelvis and its movement through the urinary system.

Inflammation of the pyelocaliceal system of the kidneys. The reason for the development is hypothermia, prolonged restraint of urination, transferred intoxication (including medicinal). Colic begins with a pulling sensation in the lower back, sometimes discomfort is associated with a disease of the spine. Treatment is conservative (antibiotics, vitamins, nonsteroidal drugs).

Tuberculosis of the kidney

The second definition is nephrotuberculosis. A dangerous disease, which is characterized by the destruction of the tissue of the organ, is accompanied by pronounced symptoms.

Main symptoms:

1. Paroxysmal pain in the lumbar region with the transition to the lower abdomen. It is difficult to stop analgesics. Initially, they manifest as dull or aching pain.
2. Staining of urine with blood.
3. An increase in body temperature to subfebrile levels.

The causes of the development of the disease are the transition of the pathological process from the lungs or bones, with their tuberculosis. Pathogens are transmitted by the hematogenous route - with the help of blood circulation.

Nephroptosis

The reasons for the prolapse of the kidney are a sharp weight loss by a significant amount of weight, back injuries, pregnancy, exhausting physical labor. For a long time, the patient does not suspect the presence of the disease. Symptoms of colic in nephroptosis appear at 2 or more stages of pathology development.

Concomitant manifestations, in addition to the characteristic paroxysmal pain in the lower back:

1. Nausea, vomiting, involuntary urination and defecation caused by reflex contraction of smooth muscles
2. Facial pallor, hypotension, increased heart rate
3. Pain in the heart (with left-sided nephroptosis)

Pathology is dangerous with multiple complications. Since it is detected in the later stages (when the renal ligament is lowered by about 6 cm), treatment is mainly surgical. But a positive result known orthopedic effects on the back and abdominal cavity (wearing corsets, bandages).

papillary adenocarcinoma

A malignant tumor of the kidney, which does not manifest itself symptomatically until the 2nd stage of development.

Reasons for the formation of a neoplasm:

• hereditary predisposition to gene mutation and the appearance of a tumor process
• transferred stress, psychologically hard work
• leading an unhealthy lifestyle (alcoholism, smoking)
• abuse of foods enriched with preservatives, thickeners, dyes
• past kidney injury
• taking a large number of different medications

Symptoms - by the time of the initial manifestation of pain, the patient has significantly reduced weight. Other signs - blood clots appear in the urine, efficiency decreases, the skin takes on a waxy tint. Due to the high degree of pain, standard analgesics are ineffective.

A disease in which urine accumulates inside the renal membranes without moving through the sections of the urinary system. A rare cause of development is vesicoureteral reflux (reflux of urine from the bladder back into the kidney). Common factors in the formation of hydronephrosis are tumors, polyps, scars, stones. These elements create an obstacle to the outflow of urine.

Renal colic has the following manifestations:

• Cramping pain in the lower back is replaced by a feeling of fullness at waist level
• Dyspeptic disorders (dry mouth, nausea and vomiting)
• High blood pressure
• Dizziness, weakness, irritability

Hydronephrosis is dangerous by organ rupture, inflammation of the abdominal cavity, and the development of sepsis (blood poisoning). Pathology is eliminated mainly by surgery.

Several veins run inside the kidneys, and squeezing even one of them leads to organ failure. The reasons for the development of pathology are a violation of blood clotting (a tendency to form blood clots), long-term use of hormonal substances. Also, renal vein thrombosis occurs due to the formation of tumors inside the organ - the neoplasm compresses the blood vessel, causing intense symptoms.

Clinical manifestations of the condition:

1. Lower back pain (severe, difficult to manage)
2. The appearance of blood in the urine
3. Level up blood pressure to high numbers
4. Formation of a conglomerate in the area lumbar back

Pathology is rarely eliminated surgically: basically, medication is prescribed. It is aimed at improving the blood supply to the affected organ. It consists of antiplatelet agents (agents that dissolve blood clots), diuretics and hemostatic drugs.

Kidney infarction

It is the death of part of its parenchyma (tissue) due to a sharp cessation of the blood supply to the organ.

Reasons for the development of pathology:

• atherosclerosis
• cardiac ischemia
• arrhythmia
• transferred medical or diagnostic measures on the organs of the urinary system
• inflammatory heart disease (pericarditis, endocarditis)

Also, the disease develops in injection drug addicts. The stable use of non-sterile syringes, needles and improvised means causes the development of endocarditis. A specific disease is accompanied by the formation of blood clots, which negatively affects the state of the kidneys, causing their failure. Treatment involves the introduction of antiplatelet agents, hemostatic drugs, thrombolytic agents, analgesics.

Symptoms

Renal colic is characterized by several pronounced symptoms, including:

1. Pain and spasms in the lower back
2. Dyspeptic phenomena - intense nausea, rather quickly turning into bouts of vomiting
3. Staining of urine with blood (caused by damage to the kidney stones, destruction of the tissues of the organ by a growing tumor, distension of the pelvis by the accumulation of urine)
4. Increase in body temperature

These symptoms create problems with the adoption of body position, cause sleep disturbance and general well-being. The attack has a wave-like character - it proceeds with episodes of a temporary weakening of intensity. During this period, the patient tries to rest, but the average duration of sleep is up to 2 hours, which negatively affects the psycho-emotional state.

Possible Complications

The consequences of conditions that are manifested by renal colic (occur with a long absence of competent treatment):

1. Sepsis. Infection of the blood resulting from the ingress of pathogenic microflora into the systemic circulation.
2. Hydronephrosis. It is not only a separate, independently developing disease, but also a consequence of other pathological conditions.
3. Renal failure. The function of the main organ of the urinary system slows down, and then completely stops.
4. Peritonitis. Abdomen- a sterile environment, and when pathogenic microflora enters it, life-threatening inflammation occurs.

Also, diseases that are accompanied by colic can lead to dehydration of the body (due to increased vomiting). This causes multiple complications: dysfunction of the heart, brain, urinary and digestive tract.

Features in pregnant women

Renal colic can cause contraction of the smooth muscles of the uterus, which can lead to premature birth or miscarriage. In pregnant women, it is difficult to eliminate an attack and the pathology that caused it: during the period of bearing a child, 95% of drugs are not administered due to harm to the fetus.

Medical care for pregnant women:

1. Pain is relieved by No-shpoy - this drug is safe during fetal development.
2. In the presence of an infectious-inflammatory process in the urogenital tract, Canephron is prescribed. These anti-inflammatory capsules are allowed during the gestation period.
3. It is possible that a woman is hospitalized in the gynecology department to maintain pregnancy.

Operations and full treatment of diseases that caused renal colic are carried out only after childbirth (if indicated).

Features in children

Children cannot always indicate the localization of pain, explain the features discomfort and list associated symptoms. Therefore, it is somewhat more difficult to stop an attack and eliminate the underlying pathology that provoked it. If there are complaints, the child needs to call a doctor at home. The specialist will exclude the presence of conditions that relate to the "acute abdomen" complex. Before the doctor arrives, you should measure your body temperature. At severe pain(1 attack lasts up to 20 minutes) it is permissible to give the child Nurofen syrup at the rate of 30 mg active substance per 1 kg of weight.

Which doctor to contact

The treatment of all conditions that manifest renal colic is handled by a urologist, children are treated by a doctor of the same profile or a pediatrician. But the root cause of the development of the underlying disease is also taken into account, so it is possible that a consultation with a gynecologist, nephrologist, oncologist will be needed. These are specialists who treat pathologies of the female reproductive system, kidney diseases, tumor processes.

Diagnostics

Consists of laboratory, hardware and instrumental parts. Informativeness is characterized by the following types of diagnostics:

1. Blood test (clinical, biochemical) - for hemoglobin, leukocytes, ESR, creatinine, bilirubin
2. Urine culture
3. Blood test for glucose
4. Fluorography (since nephrotuberculosis begins with lung damage)
5. General urinalysis
6. X-ray survey
7. Excretory urography

If it is not possible to collect enough information about the state of the paired urinary organ, the patient undergoes an MRI or CT scan. These are sophisticated imaging modalities. Thanks to them, information is obtained about the extent of inflammation, the presence of a tumor process. Also, CT and MRI determine the characteristics of the blood supply to the kidneys, the degree of destruction of the parenchyma, the presence of metastases (with adenocarcinoma). Additional types of research depend on the individual clinical case.

Treatment

It is classified into conservative and surgical types. The first option consists of the medication part, diet, hygiene measures in full. Renal colic is a medical emergency.

First aid

During an attack, you need to perform the following actions:

1. Introduce antispasmodics and analgesics - No-Shpu combined with Papaverine, Renalgan, Deksalgin, Ketanov will help to relieve discomfort.
2. Eliminate nausea and vomiting with Cerucal or Metoclopromide.
3. Introduce hemostatic drugs (if urine is intensely stained with blood) - Dicinon, Sodium etamsylate, Calcium chloride, Aminocaproic acid.

During an attack, the level of blood pressure rises, so medical care involves the introduction of antihypertensive drugs. Of the drugs, Dibazol is used in combination with Papaverine, Magnesium sulfate. Renal colic causes nervous tension, the patient cannot take a certain position of the body. Therefore, during an attack, it is not necessary to force him to adhere to bed rest. It is also contraindicated to take a hot bath or apply a heating pad to the lower abdomen. These actions increase bleeding, expand the spectrum of inflammation.

Medical therapy

Treatment of nephrotuberculosis takes from 6 to 12 months.

Pathology is eliminated:

• anti-tuberculosis drugs (Isoniazid, Rifampicin)
• fluoroquinolones (Gatifloxacin)
• non-steroidal anti-inflammatory drugs (Voltaren, Diclofenac)

Since the drugs of these groups cause intestinal dysbacteriosis, in addition, the patient needs to take Linex or Bifidumbacterin. Chemotherapy is carried out with adenocarcinoma - before and after surgery (a course of more than 3 procedures). With hydronephrosis, the kidney is prepared for surgery with medicines - antibiotics, diuretics are administered. Anesthesia of the patient in all cases is carried out only if necessary (not according to a pre-established scheme). After an operation performed on the kidney (regardless of the disease), a course of antibiotic therapy is prescribed.

Surgical intervention

It is indicated for tuberculosis, hydronephrosis, adenocarcinoma, aggravated urolithiasis, nephroptosis. With tuberculosis, a resection is performed - the affected part of the organ is removed. In violation of urination, stenting is performed or a nephrostomy is applied. In both cases, the use of special expanding tubes is assumed, due to which the outflow of urine is normalized.

With urolithiasis, stone crushing is performed. Modern clinics are equipped with laser systems, which allows destroying calculi without preliminary incisions on the body. A high-energy beam is directed to a stone located inside the renal pelvis, crushing the conglomerate to sand. Then, during the operation, the dust is washed out of the body. With nephroptosis, the stretched renal ligament is sutured, which provides the organ with an anatomically correct position.

Diet

In diseases that are accompanied by colic, nutrition involves the rejection of salty, sour, spicy foods or dishes. The use of caffeine, alcohol is contraindicated.

With stones, the dietary diet directly depends on the composition of the stones:

1. With phosphates, dairy products, cucumbers, buckwheat and pearl barley, sea fish are contraindicated.
2. The presence of xanthines implies the rejection of the use of greens, fatty meat or fish, canned food.
3. Identification of cystins involves the rejection of the use of fruits and homemade juices.
4. The presence of struvite is an indication for a ban on the presence of citrus in the diet.
5. With urates, you can not eat meat and broths from it, offal, canned food.
6. Oxalates are the basis for limiting the presence of pepper, garlic, nuts, potatoes, buckwheat, rye bread in the menu.

The drinking regimen depends on the specific clinical case. Additional use of decoctions or infusions must be agreed with the treating specialist. They belong to folk treatment and should not contradict general medical prescriptions. In 90% of cases, experts do not mind the use of rosehip broth.

Forecast

Depends on the stage of pathology at the time of treatment. With urolithiasis, the prognosis is favorable - stones are destroyed, completely removed from the body. Compliance with a diet and a moderately mobile lifestyle will avoid the re-formation of a conglomerate.

Hydronephrosis is dangerous by rupture of the organ, so the prognosis is favorable only with a timely visit to the doctor. With adenocarcinoma, survival is about 5-7 years (provided early treatment, including chemotherapy).

Kidney infarction has a favorable prognosis only after its resection. If timely surgical intervention is not carried out, failure develops and leads to death.

Nephroptosis limits the patient's ability to live and work. After the operation, you will have to wear orthopedic devices (corsets, bandages) for some time. Provided that this recommendation is followed, the health outlook is favorable.

Pyelonephritis has a peculiarity - immediately after the start of treatment, the pain subsides and the patient, feeling relieved, stops therapy. The inflammatory-infectious process takes chronic course, and the prognosis for the patient becomes unfavorable. To avoid complications, the prescribed therapy must be completed in full, without interrupting the course.

Prevention

You can avoid the development of renal colic and diseases that cause this condition if you follow simple rules:

1. Eliminate pathologies in a timely manner, prevent their transition into a protracted form
2. Comply with the rules of personal hygiene
3. Control the quality of nutrition (do not abuse salty, sour, spicy foods), abandon the idea of ​​​​observing strict diets
4. Protect the body from various types of damage
5. Avoid hypothermia, prolonged soaking in the rain
6. Do not overdo urination
7. Give up alcoholism, smoking, uncontrolled use of drugs

It is equally important to normalize working conditions, take a prophylactic course of vitamins in autumn and spring, and avoid sudden weight loss.

Renal colic is a sign of the presence of an inflammatory, tumor, destructive process. Combination diagnostic methods allows you to accurately determine the cause of back pain. The elimination of an attack is medical (it is stopped with antispasmodics), and the causes of the condition are medicinal or surgical. In pregnant women and children, therapy has features, multiple limitations. Renal colic is a signal of a violation that has occurred in the main organ of the urinary system and the basis for an examination.

Renal colic - what to do?

Separately, it is necessary to mention that after an attack of renal colic, when the ureter occlusion is eliminated, the pain syndrome becomes less pronounced ( the pain becomes aching) and a relatively large amount of urine is excreted ( accumulation of which occurred in the pelvis of the affected kidney). Impurities or clots of blood, pus, and also sand can be seen in the urine. Occasionally, individual small stones may be passed out with the urine, a process sometimes referred to as "stone birth". In this case, the passage of a stone through the urethra can be accompanied by significant pain.

Diagnosis of renal colic

It must be understood 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 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, thrombosis of mesenteric vessels, adnexitis, pancreatitis), and prevent improper 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 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 disease from other 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. It is this specialist who should be contacted first of all if renal colic is suspected.

When renal colic occurs, it makes sense to call ambulance, as this will allow earlier treatment to eliminate pain and spasm, as well as speed up the process of transportation to the hospital. In addition, the emergency physician preliminary diagnosis 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:

• interview;
• clinical examination;
• ultrasound procedure;
• radiological methods research;
• laboratory study of urine.

Interview

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 verbal description of the patient. For the diagnosis of renal colic, the time of onset of pain, its nature ( sharp, dull, aching, constant, paroxysmal), the place of its distribution, the change in its intensity when changing the position of the body and when taking painkillers.
• Nausea, vomiting. Nausea is also a subjective sensation, which the doctor can learn about only from the patient's words. The doctor needs to be informed when nausea appeared, whether it is associated with food intake, whether it is aggravated in some situations. It is also necessary to report episodes of vomiting, if any, their relationship with food intake, changes in the general condition after vomiting.
• Chills, fever. It is necessary to inform the doctor about the development of chills and elevated temperature body ( if, of course, it was measured).
• Changes in urination. During the interview, the doctor finds out if there are any changes in the act of urination, if there is an increased urge to urinate, if there was a discharge of blood or pus along with urine.
• The presence of attacks of renal colic in the past. The doctor should find out whether this attack is a new one or if there have been episodes of renal colic before.
• The presence of a diagnosed urolithiasis. It is necessary to inform the doctor about the fact of the presence of urolithiasis ( if there is one now, or was in the past).
• Diseases of the kidneys and urinary tract. The fact of having any pathologies of the kidneys or urinary tract increases the likelihood of renal colic.
• Operations or injuries of the organs of the urinary system or the lumbar region. It is necessary to inform the doctor about the surgeries and injuries of the lumbar region. In some cases, also about other surgical interventions, as this allows us to suggest possible risk factors, as well as accelerate differential diagnosis (removal of the appendix in the past rules out acute appendicitis in the present).
• Allergic reactions. Be sure to tell your doctor if you have any allergic reactions.

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

Clinical examination

During a 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 of the hand on the back in the region of the twelfth rib. emergence pain sensation during this procedure symptom of Pasternatsky) 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 during an attack can be tense). The kidneys are rarely palpable during this procedure ( 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, it may be necessary to deep palpation abdomen, gynecological examination, digital examination of the rectum.

Ultrasound procedure

Ultrasound without prior preparation may be less sensitive, but in emergency cases where urgent diagnosis is needed, the information obtained is 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 the x-ray.

With renal colic, ultrasound allows you to visualize the following changes:

• expansion of the pelvicalyceal system;
• an increase in the size of the kidney by more than 20 mm compared to the other 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 methods of research

Radiation diagnosis of renal colic includes:

• Plain x-ray of the abdomen. An overview picture of the abdomen allows you to visualize the area of ​​​​the kidneys, ureters, bladder, as well as the condition of the intestines. However, only X-ray positive stones can be detected using this research method ( 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 circulation in the kidneys, evaluate the function of the filtration and concentration of urine, and monitor the excretion of urine through the pelvicalyceal 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 picture. This method allows diagnosing blockage at any level of the ureter, regardless of the composition of the stone.
• CT scan. Computed tomography creates 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.

Computed tomography is indicated for suspected urolithiasis caused by urate ( uric acid) and coral-like ( 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 the higher price for computed tomography resorted to 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 does the outflow of urine stop, but the blood supply to the kidney is also disturbed, which, accordingly, leads to the fact that the contrast agent is not excreted by the affected organ. This study 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 allergic reaction on iodine and on a contrast agent;
• patients with myelomatosis;
• with a blood creatinine level above 200 mmol / l.

Laboratory study of urine

At laboratory research analysis of morning urine which accumulated in the bladder during the night, and the analysis of which allows one to objectively judge the composition of impurities) and daily urine ( which is collected during the day, and the analysis of which allows you to evaluate the functional ability of the kidneys).

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

• 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 quantity of bacteria;
• the level of cysteine, calcium salts, oxalates, citrates, urates ( stone-forming substances);
• creatinine concentration ( kidney function index).

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

Treatment of renal colic

First aid for renal colic

• Hot bath. A hot bath taken before the arrival of the ambulance can reduce spasm of the smooth muscles of the ureter, which helps to 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 to the abdomen on the side of the lesion.
• Drugs that relax smooth muscles(antispasmodics). Taking drugs 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 on the 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 lubricate the clinical picture and make diagnosis difficult. To relieve pain at home, you can use ibuprofen, paracetamol, baralgin, ketanov.

Medical treatment

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 of the only 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 into the body of drugs that can alleviate symptoms and eliminate the pathogenic factor. In this case, preference is given to intramuscular or intravenous injections, as they provide a faster onset of action of the drug and do not depend on the functioning 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 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

Antispasmodics

Antiemetics

Drugs that reduce urine production

In addition to the listed drugs, drugs from the group of calcium channel blockers ( nifedipine), nitrates ( isosorbide dinitrate), alpha-blockers and methylxanthines, which can reduce spasm of smooth muscles 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, drugs alkalizing urine are used.

Drugs used to dissolve uric acid stones

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

Surgery

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;
• inefficiency drug treatment;
• stones larger than 1 cm in diameter that cannot pass on their own.

Stones can be removed in the following ways:

1. remote lithotripsy;
2. contact lithotripsy;
3. percutaneous nephrolithotomy;
4. endoscopic stone removal;
5. stenting of the ureter;
6. open kidney surgery.

This method of destruction of stones is used when stones are less than 2 cm in size and 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.

Percutaneous nephrolithotomy
Percutaneous nephrolithotomy is a method of surgical removal of kidney stones, in which a small puncture is made ( about 1cm) 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 removal stones
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 remove it.

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

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

Preparation for surgical removal of stones involves the following activities:

• Delivery of analyses. Before surgical intervention must pass general analysis urine and complete blood count, do a fluorography, conduct an ultrasound and x-ray examination of the kidneys.
• Therapist's consultation. For exclusion possible contraindications and systemic pathologies, it is necessary to consult a therapist.
• Diet. Proper diet helps to avoid excess gas and accumulation stool in the intestine, which greatly simplifies the intervention. To do this, a few days before the operation, it is necessary to refuse fermented milk products, fresh vegetables, legumes. No food is allowed on the day of the procedure.

Treatment with folk remedies

The following remedies can be used to treat renal colic:

• Hot tub. As mentioned above, hot water helps to relax the smooth muscles of the ureter. 10 g can be added to water ( 2 tablespoons) grass cudweed, sage leaves, birch leaves, chamomile and linden flowers.
• Medicinal infusion. Six tablespoons of a mixture of birch leaves, harrow root, juniper fruits and mint leaves must be poured with 1 liter of boiling water and infused 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 must be poured with 5 glasses of water and boiled for 20 minutes in a water bath. Consume hot for 1-2 hours.

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

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

Urate stones can be treated with the following decoctions:

• Lingonberry decoction. Two tablespoons of a mixture of lingonberry leaves, knotweed grass, parsley root and calamus rhizomes are poured with a glass of boiling water and boiled for 10 minutes in a water bath. It is used 70 - 100 ml three times a day for 20 - 40 minutes before meals.
• Decoction of barberry. Two tablespoons of barberry fruits, 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 they insist 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 grass, rose hips are placed in 1.5 cups of boiling water and infused for an hour. Used 70 - 100 ml 3 times a day before meals.

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 herb are poured with a glass of boiling water, boiled in a water bath for 10 minutes and infused for 2 hours. Consume 50 ml 3 times a day before meals.
• A decoction of budry grass. Two tablespoons of budra grass, blue cornflower flowers, wintergreen leaves, peppermint leaves are poured with one and a half cups of boiling water, boiled for 5 minutes and infused for an hour. Use 50 ml 4 times a day before meals.
• A decoction of immortelle flowers. Two tablespoons of a mixture of immortelle flowers, budra grass, black elder 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 infused for 4 hours. Use in a warm form, 50 ml 4 times a day before meals.

Prevention of renal colic

What do we have to do?

• 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;
• adjust congenital pathologies metabolism;
• go for a walk or other physical exercise.

What should be avoided?

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, 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, 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.

• hypothermia;
• drafts;
• systemic and urological infections;
• dehydration;
• injuries of the lumbar region;
• sedentary lifestyle.