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Concept
Renal colic
Summary
Renal colic is a type of abdominal pain commonly caused by obstruction of ureter from dislodged kidney stones. The most frequent site of obstruction is the vesico-ureteric junction (VUJ), the narrowest point of the upper urinary tract. Acute obstruction and the resultant urinary stasis (disruption of urine flow) can distend the ureter (hydroureter) and cause a reflexive peristaltic smooth muscle spasm, which leads to a very intense visceral pain transmitted via the ureteric plexus.
Renal colic typically begins in the flank and often radiates to below the ribs or the groin. It typically comes in waves due to ureteric peristalsis, but may be constant. It is often described as one of the most severe pains.
Although this condition can be very painful, most ureteric stones under 5 mm size will eventually pass into the bladder without needing treatments, and cause no permanent physical damage. The experience is said to be traumatizing due to the severe pain, and the experience of passing blood and clots as well as pieces of stone. In most cases, people with renal colic are advised to drink more water to facilitate passing; in other instances, lithotripsy or endoscopic surgery may be needed. Preventive treatment can be instituted to minimize the likelihood of recurrence.
The diagnosis of renal colic is the same as the diagnosis for renal calculus and ureteric stones.
A renal colic must be differentiated from the following conditions:
biliary colic and cholecystitis
aortic and iliac aneurysms (in older patients with left-side pain, hypertension or atherosclerosis)
interstitial: appendicitis, diverticulitis or peritonitis (in this case patients prefer to lie still rather than being restless)
gynaecological: endometriosis, ovarian torsion and ectopic pregnancy
testicular torsion
Most small stones are passed spontaneously and only pain management is required. Above the rate of spontaneous stone passage decreases. NSAIDs (non-steroidal anti-inflammatory drugs), such as diclofenac or ibuprofen, and antispasmodics like butylscopolamine are used.
Official source
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