Renal colic

A syndrome observed in a number of kidney diseases, the main manifestation of which is acute pain in the lumbar region.

Etiology and pathogenesis. The most common causes of renal colic are kidney stones, hydronephrosis, nephroptosis, in which urodynamics in the upper urinary tract are disrupted. Renal colic can be caused by obstruction of the ureter by a blood clot, caseous masses due to renal tuberculosis, a tumor, as well as polycystic disease and other diseases of the kidneys and ureters. The leading role in the development of the symptom complex belongs to spasm of the urinary tract with its ischemia, stretching of the fibrous capsule of the kidney and renal pelvic reflux.

Symptoms, course. The attack most often develops unexpectedly in the form of severe pain in the lumbar region, but sometimes it is preceded by increasing discomfort in the kidney area. Walking, running, riding a motorcycle, or lifting weights often provoke an attack, but it can also occur at rest. The intensity of the pain quickly increases, the patient rushes about, unable to find a place from the pain, groans loudly, holding his sore side with his hands.

The pain is localized in the lumbar region, but then moves down along the ureter, radiating to the groin and genitals. In the urine, as a rule, red blood cells and a small amount of protein are found, sometimes - stones, salts, and blood clots. Often, with ureteral stones, renal colic is accompanied by abdominal pain and intestinal paresis, similar to the picture of an acute abdomen.

In such cases, differential diagnosis with appendicitis, cholecystitis, intestinal obstruction and pancreatitis is not easy, especially since the attack is often accompanied by nausea and vomiting, and the presence of red blood cells in the urine does not exclude the presence of appendicitis. If a small stone is localized in the lower part of the ureter or renal colic is associated with the passage of sand, then a frequent, painful urge to urinate occurs. The attack may be accompanied by chills, increased body temperature, tachycardia, leukocytosis, and increased ESR.

It can end quickly or last for many hours. The diagnosis of renal colic is made on the basis of the characteristic localization and irradiation of pain, intensifying with palpation and tapping in the kidney area, based on changes in urine, chromocystoscopy data and intravenous urography. With kidney stones and hydronephrosis, an attack can occur both during the day and at night (patients sleep on either side); with nephroptosis, pain occurs more often during the day (patients prefer to sleep on the affected side).

With chromocystoscopy during an attack, indigo carmine is not released from the affected side or its release is significantly delayed. Sometimes bullous edema, hemorrhage, or a strangulated stone are visible in the area of ​​the ureteral orifice. Outside of attacks with hydronephrosis, the release of indigo carmine is always slow, and with nephroptosis, as a rule, it is normal.

Survey radiography of the abdominal cavity in a direct projection allows us to identify shadows of radiological stones. Intravenous urography is the most valuable method for diagnosing renal colic and its differential diagnosis with acute surgical diseases of the abdominal organs. It makes it possible to detect stones and changes in the urinary tract in case of nephrolithiasis, in case of hydronephrosis - dilation of the pelvis and calyces, and in case of nephroptosis - pathological displacement of the kidney and bending of the ureter. Intravenous urography also reveals other, more rare causes of renal colic.

Treatment begins with the use of heat (heating pad, bath temperature 37-39 ° C), antispasmodics (papaverine, noshpa, platifillin) and painkillers (analgin). An attack can be stopped by intramuscular or intravenous administration of 5 ml of baralgin solution or subcutaneous injections of 1 ml of 0.1% atropine solution in combination with 1 ml of 2% promedol solution or 1 ml of 1-2% omnopon solution (administration of narcotic analgesics is permissible only with absolute confidence in that it is clinical