Symptoms of renal colic emergency care. Renal colic attack emergency care

Renal colic is understood as an abrupt onset of an attack. Often this condition is associated with, but in fact, doctors consider renal colic one of the symptoms of many pathologies of the urinary system of the body.

Causes of renal colic

Doctors say that the pain syndrome in question manifests itself against the background of a blockage of the ureter and a violation of the movement of urine. But the following reasons can lead to this state:

• , moreover, only if the stone has closed the ureter and does not allow urine to come out;
• tumors (benign or) of the kidneys - the ureter may be blocked by a blood clot or pus;
• necrotic papillitis;
• flowing in a purulent form;
• kidney injury;
• benign and / or malignant tumor of the ureter or bladder.

It is extremely rare that the cause of renal colic is compression of the ureter, which can occur during surgery on the pelvic organs, against the background of an increase in nearby lymph nodes or a tumor in the retroperitoneal space.

In order for renal colic to occur, provoking factors are needed, since the above pathologies themselves are not characterized by pain. The provoking factors in this case are:

• long road in a car or train (shake);
• medicines for the treatment of urolithiasis;
• a sharp restriction in the amount of liquid consumed, or, conversely, a sharp increase in this amount;
• hard blow to the back.

If there is a blockage of the ureter with a stone, then the result will be a violation of the outflow of urine. At the same time, new portions of urine continue to be produced in the renal tubules, there is no exit of this fluid from the body, and the pyelocaliceal system of the kidney expands. The longer the ureter is blocked, the faster the squeezing of the kidney vessels and the violation of its blood supply.

Note:the size of the stone/clot has absolutely no effect on the presence or absence of renal colic. There are cases when even a small size of a stone / clot (1-1.5 mm) provokes a powerful attack of pain.

Symptoms of renal colic

The main symptom of the condition under consideration is intense, sharp pain in the lumbar region. It can be joined by:

• blood in the urine - not always observed, but if the stone in the ureter has sharp edges or is too large, then hematuria is inevitable;
• frequent urination - occurs only if there is an obstruction to the outflow of urine in the lower parts of the ureter;
• bloating;
• complete absence of urine output - occurs with bilateral renal colic or in the case of the presence of only one kidney.

Doctors emphasize that there are quite a few pathologies that can mimic renal colic. For example, these include torsion of an ovarian cyst in a woman, sciatica, kidney infarction, acute pleurisy,. Therefore, self-treatment should never be carried out - only a specialist will be able to make an accurate diagnosis and provide qualified medical care.

Diagnostic measures for renal colic

To find out the true causes of the pain syndrome and confirm exactly renal colic, the patient is prescribed a number of examinations.

Physical examination

The doctor reveals pain in the anatomical location of the kidneys along the ureteral points. At the same time, differential diagnosis is carried out with a number of acute surgical diseases - for example, a specialist during the initial examination will distinguish an attack of acute appendicitis from renal colic.

Ultrasound procedure

With this type of examination, the doctor will see the expansion of the collecting space in the kidney, the stones in the ureters and kidneys and their exact location. with renal colic it is considered quite informative, but in some cases it will not give results - for example, with an abnormal structure of the organs of the genitourinary system, or with obesity in a patient.

Excretory urography

This method of examination is considered the most informative, is to conduct x-rays. First, a picture of the renal system is taken, then a contrast agent is injected into the patient's vein, which enters the urine quickly enough. After a certain period of time, the patient takes another X-ray - the doctor can assess the level of filling with urine with contrast of the renal pelvis, ureter, the size of the stone and the level at which it is located in the urinary system.

Excretory urography also has contraindications - an allergy to iodine (it is contained in the contrast agent used) and thyrotoxicosis.

First aid for renal colic

If the pain syndrome in question happened at home, then you need to immediately call the ambulance team. Before the arrival of specialists, it is permissible to take a warm bath or shower - this will reduce the intensity of renal colic.

Note:if there is a history of pregnancy (even the smallest period), then the bath is contraindicated! Most likely, such an intense pain attack will indicate an ectopic pregnancy, and exposure to heat can lead to rupture of the fallopian tube and the release of the ovum.

If the pain is unbearable, then before the arrival of specialists, you can take an anesthetic - for example, Baralgin or No-shpu. But this is an extremely undesirable act - such drugs "lubricate" the clinical picture and it will be difficult for the doctor to make a diagnosis.

Treatment of renal colic

If the patient is diagnosed with "renal colic", then the treatment will be selected. based on the etiology of the syndrome. For example, if the cause of the condition in question is urolithiasis, then it is possible to carry out. The essence of such treatment is the appointment of specific drugs that accelerate the process of stone exit from the ureter. But the doctor can make such appointments only after the examination confirms the presence of a small stone. As part of lithokinetic therapy, the following drugs can be prescribed:

• antispasmodic - they not only reduce the intensity of pain, but also contribute to the expansion of the ureter;
• alpha blockers - relax the smooth muscles of the walls of the ureter;
• non-steroidal anti-inflammatory - reduce swelling of the ureter and have a good analgesic effect.

Usually, when carrying out this type of therapy, the stone leaves the ureter within 2-3 days, but if this does not happen, then the doctors conduct an additional examination of the patient and decide to change the tactics of therapy - they prescribe. This method is considered the "gold standard" for urolithiasis - a directed beam of mechanical waves acts precisely on the stone and destroys it. This procedure is carried out necessarily under the control of ultrasound or X-ray, the effectiveness of such treatment is 95%.

Note:if the stone has been standing in one place for a long time, then this may result in the development of ureteral fibrosis just at the place of its localization. Therefore, even knowing about urolithiasis, the patient should not remove renal colic at home - taking potent drugs will not change the position of the stone.

Preventive measures

To prevent the development of renal colic, you should follow the recommendations of specialists:

• drink at least 2.5 liters of water daily;
• follow a balanced diet;
• limit (the best option would be to completely abandon it);
• avoid overheating;
• regularly use cranberries and lingonberries, special urological collections of medicinal herbs, but only after consultation with a urologist.

Renal colic is not just pain, but a “signal” of the body that there are problems in the kidneys and ureters. Even if the pain has been removed, it is necessary to be examined by a doctor and understand the cause of the condition in question, which will prevent the occurrence of renal colic in the future.

Renal colic- an attack of acute pain in the lumbar region, caused by acute blockage of the upper urinary tract, impaired hemodynamics in the kidney. It is observed in many diseases of the kidneys and ureters (stones, tumors, tuberculosis, hydronephrosis), as well as with the appearance of blood clots, mucus, pus that close the lumen of the urinary tract. As a result, the renal pelvis and fibrous capsule of the kidney are stretched. Symptoms: paroxysmal pain in the lower back and lateral parts of the abdomen, radiating to the inner surface of the thigh, groin, genitals. The patient's behavior is restless, he rushes about, cannot find a place for himself. Sometimes the pain is so intense that it can cause fainting and collapse. Urination is frequent, painful. Nausea, vomiting are observed. Sometimes there may be pain on palpation of the abdomen and a slight tension in the muscles of the anterior abdominal wall. sharp pain when tapping the lumbar region. In the presence of a single kidney, anuria or oliguria may be observed. In the urine - proteinuria, erythrocyturia, leukocyturia. With complete blockage of the lumen of the ureter, urine may be unchanged. Diagnosis. Based on characteristic clinical symptoms. It is necessary to differentiate renal colic from acute appendicitis, intestinal obstruction, acute cholecystitis, intestinal colic. Urgent care. Thermal procedures (hot bath or heating pad on the lower back); subcutaneous injections: 1 ml of a 0.1% solution of atropine, 1 ml of a 02% solution of platifillin, 1 ml of a 2% solution of papaverine, 1-2 ml of a 2% solution of promedol or omnopon; i / m or / in the introduction of 5 ml of baralgin, 2 ml of a 2.5% solution of halidor. A good effect is provided by urolesan (15-20 drops on a piece of sugar), cystenal (up to 20 drops on sugar), olimetin - 1-2 capsules 3-5 times a day (05 g per capsule), pinabine (up to 20 drops on sugar) , kellin - 1-2 tablets per dose (0.02 g per tablet; no-shpa - 1-2 tablets of 0.04 g or 2-4 ml of a 2% solution i / m or slowly i / v, spasmolitin in powders - 0.05-0.1 g 3-4 times a day. Hospitalization. If there is doubt about the diagnosis, there is no effect - urgent hospitalization, transportation in a supine position.

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Causes of colic and first aid

In order to understand what to do with renal colic, it is necessary to understand what is the nature of the origin of this phenomenon. The disease is characterized by sudden spasms and may be the result of such pathological changes in the body as:

• tumors in the kidney tissues;
• the presence of stones in the urinary system;
• mechanical damage to the kidneys;
• tuberculous organ damage;
• narrowing of the lumen of the ureter;
• omission of the kidney;
• various neoplasms in the uterus, prostate gland or digestive organs.

The presence of these pathologies in the body eloquently indicates the possibility of a sudden spasm in the parenchyma and failures in the urine excretion system. Renal colic is sudden, and the patient should be helped, focusing on the causes of the spasm. They can have a variety of origins:

• stones formed in the renal space;
• blood clots;
• purulent plugs;
• kink or swelling of the ureter.

You should also focus on the symptoms that manifest with severe spasm. The pain of renal colic is too excruciating and can provoke shock and loss of consciousness. Other signs of this condition are no less characteristic:

In addition, the patient may experience pain in the urethra, a sharp increase in body temperature, dizziness, nausea or vomiting.

When these symptoms appear, emergency care is needed for renal colic in order to avoid serious consequences.

Experts say that pain in renal colic develops due to the movement of stones, as well as the occurrence of pus in the renal space. Such neoplasms can clog the duct of the upper urinary tract and bring excruciating spasm suddenly, despite the general condition of the body.

In this case, the relief of renal colic should be carried out with medication, and the treatment should be comprehensive. However, in some cases, the patient experiences severe pain and needs emergency first aid. You can alleviate suffering at home by following the following algorithm of actions:

Before the arrival of medical personnel, it is better not to take painkillers. First aid for renal colic of this nature can make it difficult to make a diagnosis.

However, in case of unbearable pain, you can take analgesics: Ketonal, Nurofen.

Pain relief methods

It must be understood that self-medication can be dangerous, and it should be approached with extreme caution. If, for example, a decoction relieved pain for a short time, you should not think that the disease has receded forever, you must definitely contact a specialist for subsequent treatment.

Alternative Pain Relief

With renal colic, help can be provided through medicinal plants. Among folk recipes that relieve pain, swelling and spasms, the following remedies stand out:

1. Carrot seeds steamed with boiling water are infused for a day and taken up to 5 times a day inside half a glass.
2. A spoonful of honey is added to the infusion of lingonberry leaf boiled in a water bath. The infusion must be taken 3 times a day, 500 ml to dissolve uric acid stones.
3. A teaspoon of gruel from grated horseradish is taken in a teaspoon immediately before meals.
4. Take black radish juice with honey every 2-3 hours, a tablespoon inside.
5. Freshly prepared motherwort juice should be diluted with 100 ml of boiled water and immediately taken orally. The procedure is repeated up to three times a day.
6. A decoction of birch leaves, buds is boiled for 20 minutes and taken freshly cooked hot.
7. Drink the juice of a small onion in a tablespoon several times a day, it is able to dissolve and remove stones.
8. Compresses on the groin and kidney area from steamed oat straw. Heat relieves swelling from the affected area.
9. Horsetail herb, which is poured with boiling water and insisted for half an hour (a tablespoon of raw materials per glass of boiling water). The resulting infusion should be consumed up to two times a day for half a cup or added to the bath.

Often the symptoms of renal colic are similar to those of appendicitis, gastric ulcer, pancreatitis, intestinal obstruction, rupture of the fallopian tube, or ovarian pedicle torsion. Therefore, it is necessary to know the diagnosis exactly, considering how to relieve kidney pain with folk remedies, because some herbs can seriously harm the body.

Specialized medical care

A urologist or surgeon will be able to provide the most competent and qualified assistance, as well as correctly diagnose renal colic. However, most often the pain occurs unexpectedly, and with renal colic, first aid comes from emergency hospitalization doctors. After examination, the ambulance physician decides to transport the patient to the therapeutic or urological department. Patients with the following dynamics of the development of the disease are subject to immediate hospitalization:

With renal colic, emergency care involves an algorithm of actions of the following nature:

1. The introduction of drugs that relieve painful symptoms and stop the pathogenic cause, mainly intravenously or intramuscularly. The combination of the anti-inflammatory injections of Ketorolac or Diclofenac and the antiemetic injections of Metoclopramide is usually most effective. At the same time, myotropic antispasmodics are administered for renal colic.


2. In case of ineffectiveness of the previous combination of drugs, narcotic painkillers Tramadol, Codeine, Morphine are used in combination with injections of antispasmodic Atropine.
3. In the presence of kidney stones, they resort to the use of drugs that alkalinize urine, such as potassium citrate, sodium bicarbonate. They contribute to the dissolution and removal of neoplasms.

After relief of acute pain with too severe symptoms, the patient is hospitalized for an accurate diagnosis. For this, a number of studies are being carried out, such as:

• clinical;
• ultrasonic;
• radiological;
• laboratory.

In addition, complex therapy is carried out to eliminate pathology in a patient using vitamin-mineral complexes, diuretics. In some cases, surgical intervention is necessary, in particular, with such complications of urolithiasis as:

In conclusion, it should be noted once again that a sudden attack of pain can be a symptom of a serious pathology. It is possible to alleviate the suffering of the patient on your own only if the diagnosis to the patient was made earlier. Otherwise, it is better to call an ambulance. The specialist will tell you how to relieve pain and eliminate renal colic without negative consequences for the body, as well as hospitalize the patient for further examination and treatment.

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What causes renal colic?

The main factors in the mechanism of disorders that cause renal colic are all diseases of the urinary system that contribute to obturation (violation of the lumen) of the outflow tract and the growth of salt deposition. It can be:

• chronic inflammation (pyelonephritis, cystitis, kidney tuberculosis);
• previous injuries and surgeries;
• developmental anomalies, nephroptosis;
• diseases affecting the general metabolism (gout, diabetes mellitus).

In 70% of patients, pathology leads to urolithiasis.

Salt crystals gradually form a stone formation. The size, shape and structure depends on the chemical structure. The most traumatic consequences are oxalate stones from salts of oxalic acid. They are distinguished by sharp edges, needle-like endings.

The place of formation of the stone is often the pelvis and calyx of the kidneys. Here, crystalline compounds are deposited that are not excreted in the urine. If the stone is immobile, it may not cause any symptoms, or it may present as a dull, intermittent lower back pain.

Signs of renal colic appear when a stone moves into the ureter and is caused by:

• spasm of the muscles of the urinary tract in response to irritation of nerve receptors located in the submucosal layer;
• the attachment of a reflex spasm of the kidney vessels, which affects special zones of baroreceptors that respond to pressure drops;
• a simultaneous sharp increase in pressure inside the pelvis and calyces;
• overstretching of the fibrous capsule with accumulation of urine, the occurrence of edema and an increase in the size of the kidney.

We figured out what renal colic is from the point of view of pathogenetic disorders of the urinary tract. Now consider the leading symptoms and diagnostic problems.

Clinical manifestations of pain syndrome

The clinic can be divided into:

• period of pain
• post pain symptoms.

Most often, an attack of renal colic is the first manifestation of urolithiasis and forces the patient to resort to emergency care at any time of the day or night. Usually, patients associate the manifestation of the disease with previous long walking, shaking in transport, physical activity, and alcohol intake.

The classic features are:

• cramping pain in the lower back on one side, which appeared suddenly;
• irradiation (spread) goes to the groin, along the inner surface of the thigh.

The advancement of the stone along the ureter causes a change in irradiation. Men complain of pain in the testicles and penis. Symptoms of renal colic in women are accompanied by pain in the labia.

Irritation of the solar plexus contributes to the occurrence of:

• nausea and vomiting at the height of pain;
• intestinal paresis with stool retention;
• bloating;
• revealing unilateral tension of the abdominal and lumbar muscles.

Pain is accompanied by:

• expressed anxiety of the patient, attempts to take a comfortable position of the body;
• feeling thirsty;
• blanching of the skin;
• reduction in urine output up to complete cessation (oliguria, anuria);
• chills with fever;
• decrease in heart rate;
• increased blood pressure;
• false urges and pain when urinating.

Very intense pain and a low threshold of sensitivity of the patient contribute to the occurrence of a shock state with:

• drop in blood pressure;
• secretion of clammy cold sweat.

Characteristics of post-pain symptoms

Help with renal colic relieves or reduces pain, but there are signs of a post-pain period in the clinic.

Hematuria

Excretion of blood in the urine (hematuria) - occurs in 90% of cases. Called:

• damage to the mucous membrane of the renal pelvis, calyces, ureter by a moving stone;
• rupture of small arterioles of the kidney parenchyma due to a sharp increase in intrapelvic pressure from accumulated urine;
• a similar gap is possible after the passage of the stone with a rapid normalization of pressure.

Hematuria serves as a differential diagnostic sign with pain in tumors. It happens only in the post-pain period, and in patients with a tumor and in the pre-pain period.

Signs of hematuria are found after tapping on the lower back (definition of Pasternatsky's symptom).

Hematuria will not be detected if a urinalysis is taken during an attack with a remaining block of one ureter. Normal urine will flow through the other (intact) ureter.

urinary disorder

If the stone has been in the lower parts of the ureters adjacent to the bladder for a long time, then the following are observed:

• nocturia (increased urine output at night);
• pollakiuria (frequent urination);
• dysuric disorders (cramps, pain, false urges).

Signs of secondary cystitis occur with the rapid addition of infection. At the same time, many leukocytes and bacteria (leukocyturia, bacteriuria) are found in the urine. Perhaps the beginning of the formation of calculous pyelonephritis.

stone exit

The most reliable sign and outcome of renal colic is the passage of stones in the urine. In 1/5 patients, the process is painless.

This symptom usually occurs shortly after the pain attack. Stone washout is influenced by:

• shape (oxalates dig deep into the wall with sharp edges);
• condition of the urinary tract (possible congenital narrowing, concomitant inflammation).

What causes colic?

Factors that provoke symptoms of renal colic include:

• violation of the diet (overeating meat dishes, fried and spicy foods);
• too much or, conversely, insufficient fluid intake;
• alcohol, a significant amount of beer;
• shaking when driving on a bad road;
• overstrain of physical forces;
• infectious diseases.

These reasons can disrupt the compensatory mechanisms of the kidneys, disrupt metabolism, accelerate the damage to the urinary tract in the latent course of urolithiasis.

Features of renal colic in women and children

Renal colic in women can be caused by pregnancy and gynecological diseases:

• pathological conditions of the uterus (disturbed location, inflection);
• inflammatory diseases of the appendages (adnexitis);
• damage during tubal pregnancy;
• torsion of the "legs" with cystic changes in the ovary;
• hemorrhage and rupture (apoplexy) of the ovary;
• spontaneous miscarriage.

Therefore, any woman delivered to the hospital "Ambulance" with a diagnosis of "renal colic" should be examined by a gynecologist.

Some women with a long gestation period perceive pain as the beginning of contractions and go into labor. house. If there are no signs of labor, the patient is transferred to the pathology department, where they are fully examined and possible treatment is carried out before delivery.

In children, stone formation often depends on the presence of inflammatory kidney disease. Stones consist of mucus, fibrin, desquamated epithelium, leukocytes, bacteria. In the occurrence of renal colic, pediatricians attach importance to family predisposition. This is due to the genetically determined course of metabolism.

Risk factors for early childhood include:

• increased fluid loss (with frequent diarrhea, vomiting, development of malabsorption syndrome);
• treatment with drugs with a toxic effect on the kidneys.

In younger children, the localization of pain does not correspond to classical signs. It occurs in the navel, accompanied by bloating and vomiting. The child is in an excited state, frightened, crying. A slight increase in temperature is possible.

How to correctly diagnose?

When talking with a patient or parents of a sick baby, you need to find out everything related to the cause and nature of the disease.

Therefore, you will have to remember and answer the questions:

• how the pains began suddenly or gradually;
• where they give and how much they changed over time;
• have had chills, nausea, or vomiting;
• whether there are difficulties, cramps when urinating;
• is the attack the first or have already had similar manifestations;
• whether the diagnosis of urolithiasis was made to the patient and his relatives.

On examination, the doctor pays attention to:

• type of patient;
• painful palpation of the kidney on the affected side;
• positive symptom of Pasternatsky;
• bloating and muscle tension in the abdominal wall and in the lower back.

Violations of the filtration function of the kidneys with the accumulation of nitrogenous substances, is suspected with a change in the content of electrolytes. Anemia is found in the formation of renal failure. Urinalysis reveals a significant amount of erythrocytes, mucus, salt in the form of cylinders, moderate leukocyturia, epithelial cells.

Renal colic must be distinguished from other pathologies with similar symptoms. These include all conditions referred to by one term "acute abdomen":

• acute appendicitis;
• biliary dyskinesia, cholecystitis and pancreatitis with hepatic colic;
• perforation of stomach and duodenal ulcers;
• an attack of intestinal obstruction;
• vascular diseases such as aortic dissection, thromboembolism of the mesenteric arteries.

In women, it is imperative to exclude:

• adnexitis (inflammation of the appendages);
• ectopic pregnancy;
• possible torsion of the peduncle of the ovarian cyst.

Lower back pain radiating to the groin is accompanied by:

• intercostal neuralgia;
• herniated intervertebral disc with radicular pain syndrome;
• shingles caused by herpes infection.

For each disease, it is necessary to take into account the anamnesis, the age of the patient, the characteristics of pain and associated symptoms. The choice of measures necessary for targeted therapy depends on the correct diagnosis in order to make them most effective.

The doctor can get the maximum information when conducting:

• ultrasound examination of the kidneys and bladder, if it is completely filled;
• x-ray examination (excretory urography);
• chromocystoscopy - an endoscopic method for detecting obstruction of the ureters with the introduction of indigo carmine.

What first aid should be given in case of an attack?

First aid for renal colic can be provided before calling an ambulance at home. It is only important to be sure of urolithiasis as the cause of pain. This is possible if the patient has previously suffered similar attacks and was diagnosed during the examination.

In such cases, it is permissible to use such methods of first aid as:

• applying a hot heating pad to the lower back;
• placing the patient in a bath with warm water;
• intramuscular injection of an antispasmodic drug (No-shpy, Platyfillin, Baralgin);
• ingestion of Cystenal.

It must be remembered that thermal procedures are categorically contraindicated in inflammatory diseases, tumors, lesions of the pelvic vessels, against the background of pregnancy. The expectant mother can be allowed to take the No-shpy pill. Warming up contributes to abortion, uterine bleeding.

The algorithm of actions in providing assistance to the patient consists of pre-medical measures and the use of special medications by medical workers. In case of pain, you need to:

• call an ambulance;
• reassure the patient, find out the symptoms and the previous course of the disease;
• put a thermometer to measure temperature;
• determine together with the patient the maximum localization of pain, irradiation;
• pour hot water into a heating pad, wrap with a towel and attach to the lower back on the side of the lesion;
• give Cystenal for oral administration, if skills allow, inject one of the antispasmodics.

With a long delay of the ambulance, it is permissible to place the patient in a hot bath with water. Timely emergency care for renal colic helps preserve the kidneys and improves the outcome of further treatment.

When is the patient admitted to the hospital?

The attack is usually stopped at home by activities provided by loved ones and the ambulance. In the future, a person should consult a doctor at a polyclinic for a complete examination and treatment.

Hospitalization is considered mandatory when:

• unsuccessful actions of the ambulance staff and unresolved pain in the patient;
• a solitary kidney or a severe attack with pain in a transplanted donor organ;
• high body temperature, suspicion of infection;
• pregnancy.

In the hospital:

• continue to use antispasmodic drugs;
• use stronger painkillers;
• when pain persists, pararenal novocaine blockade is performed;
• prescribe symptomatic anti-vomiting agents;
• control blood pressure and the state of cardiac activity;
• when signs of inflammation appear, a course of antibiotic therapy is carried out;
• prescribed vitamins.

To determine further patient management tactics, the results of the examination are taken into account, the issue of planned surgical treatment is decided to install a stent and remove the stone, and indications for the use of ultrasound therapy.

Patients should understand that the removal of a stone after an attack does not mean a complete recovery. Changes in the exchange of salts in the body remain. This means that after some time another stone will form and the attack will repeat. Therefore, you should carefully consider the recommendations for diet, exercise, and medication.

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Causes of renal colic

The development of renal colic is always due to a sharp violation of the drainage of urine from the kidney, which occurs due to external compression or internal blockage of the urinary tract. This condition is accompanied by venous stasis of the kidney, increased hydrostatic intrapelvic pressure, reflex spastic contraction of the muscles of the ureter, swelling of the parenchyma, overstretching of the fibrous capsule and ischemia of the kidney. As a result, a sudden pain syndrome develops, called renal colic.

The immediate cause of such a violation may be mechanical obstructions that prevent the passage of urine from the ureter or renal pelvis. In more than 50% of all cases, colic occurs with urolithiasis due to infringement of the calculus in any of the urinary tract. Sometimes the condition provokes torsion or kink of the ureter with its strictures, kidney dystopia or nephroptosis.

Also, the cause of blockage of the urinary tract can be clots of pus or mucus in case of pyelonephritis, torn off necrotic papillae or caseous masses in case of kidney tuberculosis.

External compression of the ureter can be caused by tumors of the prostate (cancer or adenoma of the prostate), kidneys (eg, papillary adenocarcinoma), urinary duct, and post-traumatic hematomas in the retroperitoneal region.

Another group of causes of renal colic is due to congestive, inflammatory or vascular diseases of the urinary tract: hydronephrosis, prostatitis, urethritis, periurethritis, phlebostasis, renal vein thrombosis, kidney infarction, embolism, etc.

Urodynamics in the upper urinary tract may be affected by congenital anomalies such as spongy kidney, dyskinesia, achalasia, and megacalicosis.

Symptoms of renal colic

Sudden cramping and very intense pain in the costovertebral angle or in the lumbar region is a classic symptom of renal colic. Most often, a painful attack develops during sleep at night, but sometimes this condition is preceded by heavy physical exertion, long walking, shaking driving, taking large amounts of fluids or diuretics. From the lower back, pain can spread to the rectum, thigh, ileum or mesogastric region, in women - to the perineum and labia, in men - to the scrotum and penis.

The duration of an attack of renal colic can be from 3 to 18 hours or more, while the localization of pain, its intensity and irradiation can change. During this period, a person has frequent urge to urinate, later flatulence, vomiting, dry mouth, cramps in the urethra, tenesmus, anuria or oliguria develop. Against the background of colic, tachycardia, chills, moderate hypertension, low-grade fever occur. Severe pain can cause a state of shock, manifested by bradycardia, pallor of the skin, cold sweat and hypotension.

After the attack, as a rule, a significant amount of urine is released, in which the patient can detect blood.

Emergency care for renal colic

Help with renal colic should be provided by a doctor, therefore, if there is severe pain in the abdomen and lower back, an ambulance should be urgently called. The fact is that, according to clinical signs, colic is similar to many other diseases and pathologies that are also accompanied by lumbar and abdominal pains: with acute appendicitis, aortic aneurysm, ovarian torsion, ectopic pregnancy, intercostal neuralgia, acute pancreatitis, thrombosis of mesenteric vessels, cholecystitis and others

In the event that renal colic does not occur in a person for the first time, and he is sure of this diagnosis, then before the arrival of the ambulance team, the patient's condition can be alleviated.

Emergency care for renal colic is:

• Applying a heating pad to the lower back or placing the patient in a warm bath to reduce spasm of the ureter and blood vessels, while improving the blood supply to the kidney, and a blood clot or stone can slip into the bladder;
• Taking any antispasmodic and analgesic drug, preferably Papaverine, Baralgin or No-shpa, in extreme cases, if these drugs were not in the medicine cabinet, you can take Nitroglycerin.

You need to understand: the described procedures will help, provided that it is really renal colic. Otherwise, thermal procedures and painkillers can only harm, for example, in acute appendicitis, a person's condition after taking a bath and No-shpa deteriorates sharply.

Upon arrival, the ambulance doctor also uses analgesics and antispasmodics to relieve the attack, but in the form of injections - this is how they are more effective.

Treatment of renal colic

After removing the attack, the treatment of renal colic involves the elimination of the factor that led to the obstruction of the urinary tract, i.e. therapy for the underlying disease. For this, the patient is recommended to undergo the following examinations:

• Plain radiography of the abdominal cavity;
• Urinalysis;
• Urography;
• Chromocystoscopy;
• Ultrasound of the kidneys, bladder, pelvic organs and abdominal cavity;
• Computed and magnetic resonance imaging of the kidneys.

Characteristics of the disease

Colic is severe, paroxysmal pain. The prevalence of this condition among the population reaches 10%. Pain syndrome can occur in people of any age and gender. The development of this symptom may be based on the following processes:

blockage of the ureter; the formation of a blood clot that interferes with the passage of urine; deposition of salts of uric acid; blockage of the urinary tract with necrotic masses; muscle spasm of the ureter; spasm of the pelvis; accumulation of mucus or pus; renal ischemia.

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Depending on the level of the lesion, pain may be felt in the lower back, lower abdomen, or along the ureters. Most often, colic is felt on one side. Pain is the result of distension of the renal pelvis and renal capsule. Such pain is one of the most intense in medical practice. This condition requires emergency care.

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Etiological factors

Colic occurs with the following diseases and pathological conditions:

urolithiasis; kidney tuberculosis; benign and malignant tumors; hydronephrosis; narrowing of the ureter; acute pyelonephritis; torsion of the ureter; prolapse of the kidneys; dystopias; prostate cancer; benign prostatic hyperplasia.

The cause may be post-traumatic hematomas. The most common cause is the presence of stones in the kidneys or ureter. In the presence of a kidney stone, colic develops in every second patient. With blockage of the ureter - in almost all patients. Severe pain syndrome like colic can occur with inflammatory diseases (urethritis, prostatitis). Less commonly, the cause lies in vascular pathology (vein thrombosis in the kidney area, embolism). In some patients, colic is due to congenital organ anomalies (achalasia, spongy kidney).

In women, colic can develop against the background of gynecological diseases (salpingoophoritis, uterine fibroids). These diseases often lead to adhesive disease, which is a trigger for increased pressure in the kidneys. Predisposing factors for the development of renal colic include aggravated heredity (cases of colic in close relatives), previous urolithiasis, poor nutrition (excess in the diet of meat products and canned food), insufficient fluid intake, heavy physical labor, hypothermia, the presence of foci of chronic infection, the presence systemic connective tissue diseases and urethritis.

Signs of the disease

Colic appears suddenly against the background of complete well-being. In this situation, there is no triggering factor (physical activity, stress). Pain syndrome can overtake a person at work, school or at home. The main symptom of colic is pain. It has the following features:

high intensity; acute; cramping; appears unexpectedly; does not depend on human movements; localized in the lower back, on the side of the kidney or in the inguinal region; gives to the genitals, inguinal region, anus; often associated with nausea and vomiting; often manifested by a change in the nature of urine (blood appears in it).

Nausea and vomiting are observed with colic, which is caused by a violation of the outflow of urine in the kidneys or ureters. Vomiting does not improve the condition of a sick person. With obstruction of the lower ureter, the appearance of dysuric phenomena (frequent and painful urination) is possible. In some cases, ischuria occurs. Fever, chills, and general malaise indicate an inflammatory process. Stagnation of urine is a favorable factor for the activation of microorganisms, which leads to inflammation.

The duration of colic varies. It can last from 3 hours to a day or more. The pain may wax and wane. All this significantly worsens the patient's condition. He can't find a place for himself. There is marked excitability. In severe cases, colic can cause loss of consciousness. Against the background of colic, the patient may be disturbed by the following complaints:

cutting in urethra; dry mouth; decrease in diuresis; anuria; increased blood pressure; increase in heart rate.

Severe pain can lead to shock. In this case, there is pallor of the skin, the presence of cold sweat, bradycardia, and a drop in pressure.

Patient examination plan

Cramping pain can be observed not only in diseases of the genitourinary system. To establish the underlying disease, a series of studies should be carried out. Diagnosis includes taking an anamnesis, palpation of the abdomen, determining the symptom of concussion of the lumbar region, ultrasound of the kidneys and bladder, blood and urine tests, urography. Statement of diagnosis begins with a survey of the patient. During it, the characteristics of the pain syndrome and related complaints are determined. Of no small importance is the patient's indication of a violation of urination and a change in the color of urine.

With kidney damage, a positive symptom of Pasternatsky is very often detected. The most informative is the general analysis of urine. The presence of a large number of leukocytes indicates the presence of pyelonephritis. Leukocytosis in combination with hematuria may indicate urolithiasis or glomerulonephritis. With urolithiasis, fresh red blood cells are found. Ultrasound is required to rule out glomerulonephritis. Differential diagnosis of renal colic is carried out with pain in other acute diseases (appendicitis, cholecystitis, pancreatitis, peptic ulcer).

First aid

With renal colic, first aid is of great importance, since his further condition depends on the timeliness of medical care and hospitalization of a sick person. The main goal of emergency care for colic is to eliminate pain. Often there are cases when first aid for renal colic is provided at home. Colic can occur quite unexpectedly at home, on the street or at work. Everyone should know what to do in this situation. Emergency care for renal colic includes the following activities:

calling a doctor or an ambulance; providing rest for the victim; elimination of pain syndrome; warming the patient (using a heating pad); determination of body temperature and general condition of the victim; determining the location of pain.

If possible, urine should be collected. First, it is necessary to eliminate the pain with the help of thermal procedures. To do this, you can put a heating pad on the area where the pain is felt. An alternative way is to seat the victim in a bath of hot water. Heat will reduce pain and relieve the patient's condition. The use of heat is justified only in the absence of an acute inflammatory process. Hot baths are contraindicated for people who have had a stroke or heart attack. At high body temperature and other signs of intoxication, warming is not applied. If thermal procedures do not help, pain relievers (antispasmodics or analgesics) are used.

If skills allow, it is better to administer the medicine intramuscularly. To eliminate colic, you can use the following drugs:

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No-shpa; Papaverine; Drotaverine; Baralgin; Pentalgin; Platifillin; Diclofenac; Ibuprofen.

If colic does not disappear, novocaine blockades can be carried out by medical workers. In a hospital setting, catheterization or stenting can be performed. Diuretics are not used to eliminate renal colic, as stimulation of the urinary stream can lead to the movement of the stone, which can cause increased pain. Emergency care for renal colic should be carried out as early as possible. To avoid complications and pain shock, this must be done within 2-3 hours from the onset of colic. After stopping colic, a thorough examination is carried out. Further treatment is aimed at eliminating the underlying cause of colic.

Therapeutic measures

After establishing the underlying disease, treatment is carried out. With nephrolithiasis (kidney stones), treatment can be conservative or surgical. Small stones less than 3 mm in size can be removed independently. In this case, the patient is prescribed a strict diet depending on the type of stones, drinking plenty of water. Medicines are used to dissolve the stones. Antibiotics and nitrofurans are used to eliminate the inflammatory process. With frequent colic against the background of kidney stones, lithotripsy and lithoextraction can be performed. If after that the stones do not disappear, a radical operation is performed. If kidney tuberculosis is detected, long-term therapy with anti-tuberculosis drugs is carried out. Colic against the background of acute pyelonephritis requires the appointment of antibiotics. Thus, if a person has developed renal colic, the symptoms will be very pronounced. First aid is to eliminate pain and call an ambulance.

Symptoms, diagnosis and factors provoking the diseaseFirst aid in the event of an attackLimitations and contraindications in first aid

Emergency care for renal colic should be provided in the first minutes, because an attack can have severe and irreversible consequences.

Properly rendered first aid for renal colic will help the patient recover, greatly facilitate the task of doctors to stabilize the human condition.

Symptoms, diagnosis and factors that provoke the disease

Renal colic is an attack of sharp pain, which is associated with a violation of the outflow of urine from the pelvis of the kidney, but can also occur for other reasons. An attack can last for a long time and occur both during physical exertion and during a period of calm.

The pain spreads to the abdomen, thigh, shoulder, perineum, genitals. Dizziness, high blood pressure, nausea and vomiting may occur.

If there is an inflammatory process, then the temperature may rise. But such symptoms do not always occur, sometimes they can be erased.

It is necessary to differentiate spasm associated with impaired renal function and acute appendicitis when symptoms of irritated peritoneum are present. Diagnosis of the cause of an attack most often does not present any particular difficulties, because in patients the urine changes, there is frequent urination and the hypochondrium hurts on palpation.

Factors that can provoke an attack of renal colic:

diet violation; excess or lack of fluid; alcohol intake; driving on a bad road; physical or mental strain; infections.

Renal colic is a sharp pain syndrome, which is considered a sign of a number of urological diseases. Disorders in the renal system have a negative impact on a person's well-being. According to the ICD (International Classification of Diseases), the symptom is classified as renal colic, unspecified. Assigned code N23.

Renal colic is a sudden attack of acute cramping pain in the lumbar region. This dangerous condition occurs suddenly. A severe lumbar spasm develops, resembling a spasm. The pain shock is so strong that a person loses the ability to sit and move normally. He is forced to rush about, trying to get into a comfortable position in order to at least slightly ease the pain. Actually, renal colic is not considered a disease; rather, it is a symptom indicating the origin of a certain failure in the body. Pronounced symptoms are often observed after increased sports loads, motorcycle rides or bike rides.

Often there are a number of symptoms that accompany the manifestation of colic. They differ depending on the causes that provoked the disease:

• Intractable, sharp pain in the lumbar region, which has a cramping character or persists for a long time (up to 10-18 hours, in some individual cases, the period is extended to several days).
• Increased urge to urinate, accompanied by increased pain.
• Sudden darkening of the urine due to the appearance of blood in it.
• Nausea and vomiting without relief.
• Abdominal distension associated with difficulty in passing intestinal gases.
• False urge to empty the bowels and bladder.
• High blood pressure (as a rule, in this case, the use of drugs that reduce it does not bring a strong effect).
• Increased heart rate.
• Body shaking chills, fever (if the cause is an infection).
• Increased body temperature, dry mouth and headache (as evidence that an acute inflammatory process has begun in the kidneys).

In women, the symptoms are sometimes supplemented by pain in the labia. In men - pain in the penis and scrotum. When diagnosing, this can cause difficulties.

This painful syndrome, accompanied by bouts of pain in the navel, lower back and lower abdomen, can also occur in school-age children.

Factors that increase the risk of colic

The causes are varied:

• genetic predisposition.
• Urolithiasis disease.
• Natural defects of the urinary system.
• Infectious diseases of the urinary tract.
• Formation of thrombi in the venous system of the vessels of the kidneys.
• Limited fluid intake in hot weather.
• Consequences of injuries (hematomas formed near the kidneys).
• Developing pyelonephritis.
• Prolonged high physical activity.

Diseases responsible for the onset of renal colic

In women, a similar attack occurs when:

• Pathologies of the uterus.
• Inflammatory process in the area of ​​appendages.
• Tissue rupture or torsion of an ovarian cyst.
• Polycystic kidney.
• Cyst, jade.
• Ectopic pregnancy.
• Miscarriage (spontaneous abortion).

In men with these diseases:

• Urolithiasis (formation of sand and stones in the urinary system).
• Uraturia (high salt content in the body).
• Oxaluria (washout of calcium and metabolic disorders).
• Phosphaturia (urological disease, phosphate imbalance).
• Cystinuria (the formation of cystine crystals or kidney stones, a genetic urological disease).
• Congenital pathologies and injuries.
• Pyelonephritis, tuberculosis.
• Tumors (malignant neoplasms).

First aid

The occurrence of conditions that are accompanied by renal colic requires qualified diagnosis and treatment with medications. What to do if you first encountered a similar syndrome? Call a doctor for a checkup as soon as possible. Medical emergency will determine the patient's condition and decide on the need for hospitalization.

It is undesirable to use analgin and baralgin tablets available in any medicine cabinet. In the described case, they are ineffective and will not produce a complete relief of severe pain. To reduce the pain attack, you should try to alleviate the patient's condition as much as possible. He is given the necessary first aid for renal colic.

Before the arrival of an ambulance, or if it is temporarily not possible to call doctors, it is recommended to carry out the indicated algorithm of actions to reduce the strength of pain:

• Increase drinking regimen. Give more fluids to drink.
• Provide the patient with a vertical position so that his lower back is in an elevated state.
• Use a warm heating pad on your lower back.
• At the very beginning of an attack, it is permissible to offer to take a relaxing bath with hot water in a sitting position.
• If it was possible to anesthetize the attack, and the kidneys continue to disturb, intramuscular injections should be given. Take painkillers or antispasmodics that relax the muscles. Medicines help: no-shpa, drotaverine, papaverine, spasmalgon. If the listed drugs were not found, it is possible to dissolve a nitroglycerin tablet.
• If first aid is provided at home, it is forbidden to ignore any urge to urinate. It is supposed to provide an opportunity to relieve the need even in a prone position.
• Assistance associated with heating the lumbar region (heater, bath) is possible only for patients who have left-sided colic. If the colic is bilateral or right-sided, you must first exclude the diagnosis of appendicitis (inflammation of the appendix).
• Important! Before the appearance of medical workers, it is forbidden to take analgesics that can distort the symptoms, and the correct diagnosis of the disease will be very difficult.

A stone blocking the ureter always causes an inflammatory process. Even taking into account the fact that in the process of providing first aid it was possible to relieve pain, the patient will still need to be examined by a specialist. When the stone is small and can easily come out on its own, doctors prescribe:

1. A drug that improves blood circulation in the kidney is pentoxifylline or trental.
2. Antibiotics that eliminate inflammation in the ureter - ceftriaxone, fosfomycin, nitroxoline.
3. Anti-inflammatory drugs - diclofenac, lornoxicam, ketorolac.

If pain relief with medication has helped, the patient may not be taken to the hospital. In this case, according to the doctor's instructions, bed rest is recommended.

Who is hospitalized first?

Regardless of the nature of the symptom, the following categories of patients are subject to mandatory hospitalization:

• Child;
• Pregnant woman;
• A person of advanced age;
• Patient with a single kidney;
• If there is bilateral colic (left and right).

A trip to the hospital is necessary if:

• The antispasmodic or pain reliever did not have the desired effect.
• Blood pressure and body temperature are very high.
• Urine ceases to be excreted because the urinary system is blocked by a stone.
• There was a suspicion of an ectopic pregnancy, inflammation of the appendix or intestinal obstruction.

Treatment in a hospital

In the hospital, the main treatment for colic is aimed at eliminating pain and eliminating kidney stones. The selection of a technique in a particular case is carried out depending on the size of the stone, its location, the duration of the disease and the length of time, how long the syndrome manifested itself, the presence of possible complications and other factors affecting its course.

The generally accepted approach to eliminating the disease is to administer analgesics and antispasmodics intramuscularly or intravenously (dropper). In rare cases, when conventional remedies cannot relieve pain, narcotic analgesics are prescribed.

The clinic performs the operation, if the implementation of such procedures did not bring the patient the long-awaited relief, there were complaints of a deterioration in well-being. There is a high risk of serious complications. Modern urology makes it possible to treat urolithiasis and remove formed stones with minimal surgical intervention. Most often this happens painlessly.

Diet of renal patients

All diseases have certain characteristics and require a proper nutrition system. Proper adherence to a therapeutic diet is important for people with kidney disease. Food that irritates kidney cells is completely excluded from their diet. The taboo applies to canned foods, spicy, salty and sour dishes, smoked meats and seasonings with an excess of pepper. Preference should be given to the use of vegetable dishes and fruits. At the same time, it is undesirable to eat radish, spinach, cauliflower, celery and garlic.

It is recommended to consume bread products made from wholemeal flour (helps to reduce the amount of calcium in the urine and reduce the process of stone formation). Such bread is useful, its use is the prevention of such conditions. Good for preventing relapse.

Scientists have found that it is possible to prevent the formation of kidney stones by increasing the amount of magnesium in the body. If magnesium preparations are taken together with vitamins B6, the effect of the application increases. These substances are found in corn cobs and buckwheat, bran, wheat crops, potato tubers, avocados and bananas.

Remember that vitamin D increases the amount of calcium in the body and reduces the amount of magnesium, which leads to an increase in the formation of stones and causes a second attack. In large quantities, the vitamin is found in animal products (butter, eggs, liver of animals and fish). Therefore, they try to refuse such products.

In moments of severe exacerbation, the following items should be excluded from the diet:

• Cocoa.
• Coffee.
• Bold.
• Smoked.
• Canned.
• Sweet soda.
• Alcohol.

The amount of salt in food is minimal, it is advisable not to use it. Soups from cereals, vegetable or fruit are suitable as first courses. For the latter, steam cutlets or meatballs, low-fat boiled or stewed meat in sour cream are recommended. Suitable milk porridge: millet or rice with apricots, plums, apples and pumpkin. From vegetables, fresh cucumbers, white cabbage, potatoes, beets, tomatoes are recommended. The patient excludes legumes from the diet. When an exacerbated inflammatory disease subsides, it is possible to diversify the diet - add fish, poultry, cottage cheese, slightly fried meat.

Treatment with folk remedies

Along with the traditional and familiar methods of eliminating renal colic, traditional medicine also has methods of disposal that have been tested for centuries.

Should be taken:

• Decoctions of celandine grass, pumpkin seeds, rosehip roots.
• Medicinal collection of cumin fruits, buckthorn bark, marshmallow root and mint leaves.
• A decoction of flaxseed.
• Helps the consumption of watermelon up to 2.5 kilograms per day.

What type of treatment is preferred?

It is up to you to decide whether to entrust health, medications or alternative medicine recipes. If you notice signs of renal colic, try not to self-medicate. So you will avoid unpleasant consequences. Remember that even completely self-controlled pain can return at the wrong time. Take care of yourself and loved ones!

Renal colic is a complex symptom complex that includes the reactions of all body systems and manifests itself as a pain syndrome, the causes of which may be different. It usually occurs with an acute violation of the outflow of urine due to obstruction of the upper urinary tract by a calculus, a blood clot, mucus or pus, a conglomerate of urinary salts, caseous masses, shedding necrotic papillae, as a result of an inflection of the ureter or spasm of the renal pelvis, ureter. Renal colic can be observed in functional disorders of the upper urinary tract, circulatory disorders in the kidneys and ureters, in the treatment of glucocorticoids, in allergic and other diseases.

Assistance at the prehospital stage:

1. Heat in the form of heating pads, heated sand, hot baths (temperature 40-50 ° C).

2. Intramuscular injection of one of the antispasmodics (atropine 0.1% solution 1 ml, platyfillin 0.2% solution 1 ml, papaverine 2% solution 2 ml, no-shpa 2% solution 2 ml, magnesium sulfate 25% solution 10 ml) or painkillers (analgin 50% solution 1 ml, promedol 1% solution 1 ml, omnopon 2% solution 1 ml).

3. The use of narcotic analgesics in renal colic is permissible only with the exclusion of diseases of the abdominal organs in the case when the pain is not stopped by other drugs.

4. Drugs belonging to the group of spasmoanalgesics (baralgin, spazgan, trigan, maxigan) are widely used. One of the best drugs for pain relief should be recognized as baralgin (5 ml), which is most effective when administered intravenously. The drug is contraindicated in patients with an allergic reaction to analgesics.

5. After providing emergency care, the patient is urgently hospitalized in the urological or surgical department, where the diagnosis is clarified and adequate treatment is carried out.

Help at the hospital stage:

1. For the relief of renal colic, it is used intravenously

- Platifillin (0.2% 1 ml) + promedol (1% 1 ml) + diphenhydramine (1% 1 ml).

- Papaverine (2% 2 ml) + promedol (1% 1 ml) + analgin (50% 1 ml) + pentamine (5% 0.5-1 ml).

- Halidor (2.5% 2 ml) + papaverine (2% 2 ml) + diphenhydramine (1% 1 ml) + chlorpromazine (2.5% 1 ml).

- No-shpa (2% 2 ml) + pipolfen (2.5% 2 ml).

2. In order to eliminate an acute pain attack, intravenous administration of fentanyl (0.005% solution, 2 ml) is also used in combination with droperidol (0.25% solution, 2 ml) and no-shpa (2% solution, 2 ml). Usually, after the injection, the pain disappears after a few minutes.

3. An effective means of stopping renal colic is intravenous administration of prostaglandin blockers (indomethacin, voltaren, diclofenac sodium at a dose of 50 mg), which reduce diuresis by 50%, which leads to the disappearance of pain.

4. For therapeutic, as well as differential diagnostic purposes, it is possible to block the spermatic cord in men or the round ligament of the uterus in women according to Lorin-Epstein:

- the skin of the inguinal region on the diseased side is treated with alcohol, iodine and the index finger of the left hand, the external opening of the inguinal canal and the spermatic cord emerging from it are determined;

- the spermatic cord is fixed between the index and thumb of the left hand, and 5-8 ml of a 0.5% solution of novocaine is injected subcutaneously with the right;

- the needle is advanced to the spermatic cord and injected into it and the surrounding tissues with 50 ml of a 0.25% solution of novocaine;

- in women, the same amount of novocaine is injected into the subcutaneous tissue at the exit point of the round ligament of the uterus from the external opening of the inguinal canal.

After novocaine blockade, renal colic subsides in 15-20 minutes; in acute diseases of the abdominal cavity, pain does not decrease.

5. Sometimes paravertebral blockade with chloroethyl is used to relieve an attack of renal colic. For this, the skin of the paravertebral region from T11 to L3 is irrigated with chloroethyl on the side of the lesion until it turns white. Paravertebral blockade with chlorethyl on the right allows differential diagnosis between renal colic and acute appendicitis. With renal colic, the pains disappear completely or decrease, with acute appendicitis they persist, their intensity does not decrease.

6. In order to prevent repeated attacks of renal colic and as additional means of eliminating acute pain syndrome, patented combined preparations are used: cystenal, urolesan, pinabine, enatin, olimetin.

Providing timely emergency care to a patient with renal colic contributes to the rapid recovery of impaired organ functions and prevents the occurrence of severe complications. Each patient after the elimination of renal colic needs a detailed urological examination.

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Causes of renal colic

Renal colic is a sharp, paroxysmal pain that radiates to the lower back. Sometimes it is felt in the ureters (in the direction of urine) or in the lower abdomen. Most often, the pain focus is localized on one side.

Pain during renal colic is caused by stretching of the renal pelvis. Such pain is considered one of the most acute and intense.

Kidney spasm is a manifestation of the following pathologies in the body:

• urolithiasis disease;
• renal tuberculosis;
• exacerbation of pyelonephritis;
• the presence of diseases that cause problems with metabolism (diabetes mellitus, gout).

Sometimes an attack of renal colic occurs due to trauma or the consequences of surgery. In almost half of the cases, it is not possible to determine the cause of spasms.

Symptoms and first aid

Attacks of colic are always sudden and very painful. In such a situation, first aid will help to significantly alleviate the suffering of the patient. Before taking any action, you need to understand the symptoms associated with an attack.

The main signs of colic

Renal colic occurs in both adults and children. This condition has no age or gender restrictions. The main symptom is a sharp, cramping pain.

Usually the pain is localized in the lumbar region or on the side of the kidney. When colic is caused by urolithiasis, discomfort can be felt in different places. This is caused by the movement of the stone through the ureter. Men often experience pain in the groin, testicles and penis, while women feel pain in the perineum, labia. Children usually complain of pain at the navel.

The pain is accompanied by the following symptoms:

• the patient is restless, trying to take the most comfortable position of the body;
• strong thirst;
• pale skin;
• high fever, chills;
• false urge to urinate;
• cutting pain when passing urine;
• obstruction of the outflow of urine.

If the intensity of pain is very high, the patient may experience a state of shock up to loss of consciousness. The skin is covered with a cold sticky sweat, the pressure rises sharply.

Attention! If a patient has an attack of pain in the kidneys, you should immediately call a doctor. Renal colic can last from several hours to days.

How to stop pain at home

An attack overtakes a person without choosing a place and time. If this happens, first aid is needed for renal colic.

In order not to harm the patient and not provoke an increase in pain, you must follow the emergency care algorithm for renal colic.

1. Immediately call the ambulance.
2. Try to calm the patient, find out the symptoms of his condition.
3. Measure body temperature.
4. Attach a heating pad filled with hot water to the lower back (pre-wrap with a cloth).
5. Place the patient in a warm bath.

It is allowed to enter antispasmodics only with the ability to make intramuscular injections (No-shpa, Baralgin). If it is not possible to administer the drug intramuscularly, the listed drugs can be used in the form of tablets.

Thermal exposure can provoke uterine bleeding and even miscarriage, so it is better for pregnant women in case of a kidney attack to refuse a heating pad and a bath. It is allowed to take a pill No-shpy and wait for the arrival of a doctor.

Attention! If the patient cannot urinate, in no case should you give him diuretics. They will only increase the speed of stone movement and worsen the patient's condition.

Alternative Treatments

Medicinal herbs can also help with renal colic. To achieve a positive effect, you can use the following plants:

• celandine;
• flax-seed;
• carrot seeds;
• rose hip.

Celandine: 2 tbsp. spoons of crushed raw materials are poured with a glass of boiling water. After cooling, the broth is decanted and taken twice a day before meals.

Flaxseed: 1 teaspoon of seeds should be boiled in 1 glass of water, take half a glass a day every 2 hours. The decoction may be diluted with water. Take the remedy for two days.

Carrot seeds: 1 tbsp. a spoon is diluted with a glass of boiling water. The broth is infused, wrapped in a cloth, for about 12 hours, after which it is decanted. Take 1/2 cup of warm decoction before meals for 2 days.

Rose hips: chopped roots in the amount of 2 tablespoons are boiled in two glasses of water for about 15 minutes. The resulting liquid is wrapped with a cloth and infused until completely cooled, decanted. Apply the resulting remedy up to four times a day, drinking 1/2 cup at a time. The course lasts seven days.

Important! Self-medication can be hazardous to health.

It is worth taking folk remedies with caution, being sure of the good tolerance of the components of the drug.

Specialized medical care in a hospital

A urologist or a surgeon can state renal colic, they also prescribe the optimal treatment. Since seizures often begin suddenly, emergency care is provided by emergency doctors. After examining the patient, doctors decide whether a referral to the urological or therapeutic department is necessary.

Immediate hospitalization is necessary in the following cases:

• medical care at home does not give the expected results (severe pain persists);
• temperature above 39 degrees;
• the patient's only kidney;
• pregnancy of any term or suspicion of it.

After the patient is admitted to the hospital, a set of measures is taken to confirm the diagnosis:

• Ultrasound (will help to see the stone);
• radiography;
• laboratory and clinical research.

When the diagnosis is confirmed, the patient is assigned to inpatient treatment. At this stage, the following methods of therapy are used:

• further use of antispasmodics;
• the appointment of stronger painkillers;
• control of blood pressure and cardiac activity;
• the use of antibiotics (in the event of inflammatory processes);
• prescribing a course of vitamins.

The patient must understand that the relief of pain syndromes and even the removal of stones does not guarantee recovery. After a certain period of time, a new calculus may form. To prevent new attacks, the patient must comply with all the doctor's instructions: a strict diet, the right choice of physical activity and taking the necessary medications are important.

Restrictions and possible contraindications

It is necessary to provide first aid in case of attacks of renal colic, taking into account the following features of the patient:

• the reasons that caused the attack;
• the age group in which the patient is included;
• the presence or absence of comorbidities.

If the patient is taking any medications, antispasmodics should be excluded - such drugs do not always combine well with other medications. The age of the patient must also be taken into account. Elderly people are not recommended to be put in a warm bath - this is a big burden on the body. Also, the bath is prohibited for people who have had a heart attack or stroke. It is enough to limit yourself to a heating pad or mustard plasters.

An attack of renal colic is not only painful, but also extremely dangerous. Fortunately, you can beat the attack at home.

The main thing in this situation is not to get confused and know a clear first aid algorithm. It must be remembered that the temporary elimination of the symptoms of colic does not exclude the obligatory trip to a specialist in the future.

Immediate assistance in these situations is to call the ambulance team - the doctors will take the necessary measures to eliminate the attack.

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Symptoms, diagnosis and factors that provoke the disease

Renal colic is an attack of sharp pain, which is associated with a violation of the outflow of urine from the pelvis of the kidney, but can also occur for other reasons. An attack can last for a long time and occur both during physical exertion and during a period of calm.

The pain spreads to the abdomen, thigh, shoulder, perineum, genitals. Dizziness, high blood pressure, nausea and vomiting may occur.

If there is an inflammatory process, then the temperature may rise. But such symptoms do not always occur, sometimes they can be erased.

It is necessary to differentiate spasm associated with impaired renal function and acute appendicitis when symptoms of irritated peritoneum are present. Diagnosis of the cause of an attack most often does not present any particular difficulties, because in patients the urine changes, there is frequent urination and the hypochondrium hurts on palpation.

Factors that can provoke an attack of renal colic:

• diet violation;
• excess or lack of fluid;
• alcohol intake;
• driving on a bad road;
• physical or mental strain;
• infections.

First aid in case of an attack

The key to a favorable and successful treatment is correctly provided first aid and urgent hospitalization. Therapeutic measures are acceptable if the diagnosis is established earlier and you do not doubt its correctness.

To provide first aid for renal colic, you need to have an idea about the methods of stopping an attack. Urgent relief of acute pain is the main task of first aid, which can be solved with the help of thermal procedures and the use of antispasmodic and analgesic drugs.

First aid algorithm:

• call a doctor;
• provide peace;
• determine the side and place where the pain is intense;
• control the temperature;
• collect urine for visual examination;
• put a heating pad on the lumbar region or fill the bath with water;
• make injections of one of the listed antispasmodic and analgesic drugs: noshpa, baralgin, ketan, cystenal, papaverine.

If the procedures do not bring the desired effect, you can use medications. The best drug for pain relief is baralgin. Do not use diuretics, because their use can provoke the movement of a stone in the ureter or other undesirable effects.

The attack should stop within 2-3 hours. In the absence of a positive effect, emergency hospitalization in the urological department is needed.

If an attack of renal colic is complicated by acute pyelonephritis and there is a high temperature, then it is impossible to carry out thermal procedures, it is urgent to call a doctor.

In most cases, increased heating of the affected area either reduces pain or removes it completely.

Proper and timely assistance will restore the functions of the organ and prevent serious complications.

Then it is necessary to be examined by a doctor, who will prescribe a more detailed examination and further treatment, depending on the severity of the disease.

Taking antibiotics, installing a stent to drain urine, novocaine blockade, surgery - there are many treatment options.

Restrictions and contraindications in the provision of first aid

Renal colic causes severe pain, which must be urgently eliminated. It is not difficult to provide it if you know the list of necessary actions.

Emergency care for renal colic should be provided taking into account:

• patient's age;
• the presence of concomitant diseases;
• causes of an attack.

An elderly person who has a list of diseases should be treated with great care, because a hot bath is a burden on the body. If he suffered a stroke or heart attack, then the bath is strictly forbidden to take. It is necessary to put mustard plasters, a heating pad, warm sand on the sore spot.

Pain injections should not be given without knowing how they will interact with other medications that the patient was taking before the attack.

First aid in such cases should be to call a specialist who will take urgent measures to eliminate discomfort. He clearly knows the ambulance algorithm, which consists in establishing a preliminary diagnosis and providing assistance according to the indications corresponding to it.

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What causes renal colic?

The main factors in the mechanism of disorders that cause renal colic are all diseases of the urinary system that contribute to obturation (violation of the lumen) of the outflow tract and the growth of salt deposition. It can be:

• chronic inflammation (pyelonephritis, cystitis, kidney tuberculosis);
• previous injuries and surgeries;
• developmental anomalies, nephroptosis;
• diseases affecting the general metabolism (gout, diabetes mellitus).

In 70% of patients, pathology leads to urolithiasis.

Salt crystals gradually form a stone formation. The size, shape and structure depends on the chemical structure. The most traumatic consequences are oxalate stones from salts of oxalic acid. They are distinguished by sharp edges, needle-like endings.

The place of formation of the stone is often the pelvis and calyx of the kidneys. Here, crystalline compounds are deposited that are not excreted in the urine. If the stone is immobile, it may not cause any symptoms, or it may present as a dull, intermittent lower back pain.

Signs of renal colic appear when a stone moves into the ureter and is caused by:

• spasm of the muscles of the urinary tract in response to irritation of nerve receptors located in the submucosal layer;
• the attachment of a reflex spasm of the kidney vessels, which affects special zones of baroreceptors that respond to pressure drops;
• a simultaneous sharp increase in pressure inside the pelvis and calyces;
• overstretching of the fibrous capsule with accumulation of urine, the occurrence of edema and an increase in the size of the kidney.

We figured out what renal colic is from the point of view of pathogenetic disorders of the urinary tract. Now consider the leading symptoms and diagnostic problems.

Clinical manifestations of pain syndrome

The clinic can be divided into:

• period of pain
• post pain symptoms.

Most often, an attack of renal colic is the first manifestation of urolithiasis and forces the patient to resort to emergency care at any time of the day or night. Usually, patients associate the manifestation of the disease with previous long walking, shaking in transport, physical activity, and alcohol intake.

The classic features are:

• cramping pain in the lower back on one side, which appeared suddenly;
• irradiation (spread) goes to the groin, along the inner surface of the thigh.

The advancement of the stone along the ureter causes a change in irradiation. Men complain of pain in the testicles and penis. Symptoms of renal colic in women are accompanied by pain in the labia.

Irritation of the solar plexus contributes to the occurrence of:

• nausea and vomiting at the height of pain;
• intestinal paresis with stool retention;
• bloating;
• revealing unilateral tension of the abdominal and lumbar muscles.

Pain is accompanied by:

• expressed anxiety of the patient, attempts to take a comfortable position of the body;
• feeling thirsty;
• blanching of the skin;
• reduction in urine output up to complete cessation (oliguria, anuria);
• chills with fever;
• decrease in heart rate;
• increased blood pressure;
• false urges and pain when urinating.

Very intense pain and a low threshold of sensitivity of the patient contribute to the occurrence of a shock state with:

• drop in blood pressure;
• secretion of clammy cold sweat.

Characteristics of post-pain symptoms

Help with renal colic relieves or reduces pain, but there are signs of a post-pain period in the clinic.

Hematuria

Excretion of blood in the urine (hematuria) - occurs in 90% of cases. Called:

• damage to the mucous membrane of the renal pelvis, calyces, ureter by a moving stone;
• rupture of small arterioles of the kidney parenchyma due to a sharp increase in intrapelvic pressure from accumulated urine;
• a similar gap is possible after the passage of the stone with a rapid normalization of pressure.

Hematuria serves as a differential diagnostic sign with pain in tumors. It happens only in the post-pain period, and in patients with a tumor and in the pre-pain period.

Signs of hematuria are found after tapping on the lower back (definition of Pasternatsky's symptom).

Hematuria will not be detected if a urinalysis is taken during an attack with a remaining block of one ureter. Normal urine will flow through the other (intact) ureter.

urinary disorder

If the stone has been in the lower parts of the ureters adjacent to the bladder for a long time, then the following are observed:

• nocturia (increased urine output at night);
• pollakiuria (frequent urination);
• dysuric disorders (cramps, pain, false urges).

Signs of secondary cystitis occur with the rapid addition of infection. At the same time, many leukocytes and bacteria (leukocyturia, bacteriuria) are found in the urine. Perhaps the beginning of the formation of calculous pyelonephritis.

stone exit

The most reliable sign and outcome of renal colic is the passage of stones in the urine. In 1/5 patients, the process is painless.

This symptom usually occurs shortly after the pain attack. Stone washout is influenced by:

• shape (oxalates dig deep into the wall with sharp edges);
• condition of the urinary tract (possible congenital narrowing, concomitant inflammation).

What causes colic?

Factors that provoke symptoms of renal colic include:

• violation of the diet (overeating meat dishes, fried and spicy foods);
• too much or, conversely, insufficient fluid intake;
• alcohol, a significant amount of beer;
• shaking when driving on a bad road;
• overstrain of physical forces;
• infectious diseases.

These reasons can disrupt the compensatory mechanisms of the kidneys, disrupt metabolism, accelerate the damage to the urinary tract in the latent course of urolithiasis.

Features of renal colic in women and children

Renal colic in women can be caused by pregnancy and gynecological diseases:

• pathological conditions of the uterus (disturbed location, inflection);
• inflammatory diseases of the appendages (adnexitis);
• damage during tubal pregnancy;
• torsion of the "legs" with cystic changes in the ovary;
• hemorrhage and rupture (apoplexy) of the ovary;
• spontaneous miscarriage.

Therefore, any woman delivered to the hospital "Ambulance" with a diagnosis of "renal colic" should be examined by a gynecologist.

Some women with a long gestation period perceive pain as the beginning of contractions and go into labor. house. If there are no signs of labor, the patient is transferred to the pathology department, where they are fully examined and possible treatment is carried out before delivery.

In children, stone formation often depends on the presence of inflammatory kidney disease. Stones consist of mucus, fibrin, desquamated epithelium, leukocytes, bacteria. In the occurrence of renal colic, pediatricians attach importance to family predisposition. This is due to the genetically determined course of metabolism.

Risk factors for early childhood include:

• increased fluid loss (with frequent diarrhea, vomiting, development of malabsorption syndrome);
• treatment with drugs with a toxic effect on the kidneys.

In younger children, the localization of pain does not correspond to classical signs. It occurs in the navel, accompanied by bloating and vomiting. The child is in an excited state, frightened, crying. A slight increase in temperature is possible.

How to correctly diagnose?

When talking with a patient or parents of a sick baby, you need to find out everything related to the cause and nature of the disease.

Therefore, you will have to remember and answer the questions:

• how the pains began suddenly or gradually;
• where they give and how much they changed over time;
• have had chills, nausea, or vomiting;
• whether there are difficulties, cramps when urinating;
• is the attack the first or have already had similar manifestations;
• whether the diagnosis of urolithiasis was made to the patient and his relatives.

On examination, the doctor pays attention to:

• type of patient;
• painful palpation of the kidney on the affected side;
• positive symptom of Pasternatsky;
• bloating and muscle tension in the abdominal wall and in the lower back.

Violations of the filtration function of the kidneys with the accumulation of nitrogenous substances, is suspected with a change in the content of electrolytes. Anemia is found in the formation of renal failure. Urinalysis reveals a significant amount of erythrocytes, mucus, salt in the form of cylinders, moderate leukocyturia, epithelial cells.

Renal colic must be distinguished from other pathologies with similar symptoms. These include all conditions referred to by one term "acute abdomen":

• acute appendicitis;
• biliary dyskinesia, cholecystitis and pancreatitis with hepatic colic;
• perforation of stomach and duodenal ulcers;
• an attack of intestinal obstruction;
• vascular diseases such as aortic dissection, thromboembolism of the mesenteric arteries.

In women, it is imperative to exclude:

• adnexitis (inflammation of the appendages);
• ectopic pregnancy;
• possible torsion of the peduncle of the ovarian cyst.

Lower back pain radiating to the groin is accompanied by:

• intercostal neuralgia;
• herniated intervertebral disc with radicular pain syndrome;
• shingles caused by herpes infection.

For each disease, it is necessary to take into account the anamnesis, the age of the patient, the characteristics of pain and associated symptoms. The choice of measures necessary for targeted therapy depends on the correct diagnosis in order to make them most effective.

The doctor can get the maximum information when conducting:

• ultrasound examination of the kidneys and bladder, if it is completely filled;
• x-ray examination (excretory urography);
• chromocystoscopy - an endoscopic method for detecting obstruction of the ureters with the introduction of indigo carmine.

What first aid should be given in case of an attack?

First aid for renal colic can be provided before calling an ambulance at home. It is only important to be sure of urolithiasis as the cause of pain. This is possible if the patient has previously suffered similar attacks and was diagnosed during the examination.

In such cases, it is permissible to use such methods of first aid as:

• applying a hot heating pad to the lower back;
• placing the patient in a bath with warm water;
• intramuscular injection of an antispasmodic drug (No-shpy, Platyfillin, Baralgin);
• ingestion of Cystenal.

It must be remembered that thermal procedures are categorically contraindicated in inflammatory diseases, tumors, lesions of the pelvic vessels, against the background of pregnancy. The expectant mother can be allowed to take the No-shpy pill. Warming up contributes to abortion, uterine bleeding.

The algorithm of actions in providing assistance to the patient consists of pre-medical measures and the use of special medications by medical workers. In case of pain, you need to:

• call an ambulance;
• reassure the patient, find out the symptoms and the previous course of the disease;
• put a thermometer to measure temperature;
• determine together with the patient the maximum localization of pain, irradiation;
• pour hot water into a heating pad, wrap with a towel and attach to the lower back on the side of the lesion;
• give Cystenal for oral administration, if skills allow, inject one of the antispasmodics.

With a long delay of the ambulance, it is permissible to place the patient in a hot bath with water. Timely emergency care for renal colic helps preserve the kidneys and improves the outcome of further treatment.

When is the patient admitted to the hospital?

The attack is usually stopped at home by activities provided by loved ones and the ambulance. In the future, a person should consult a doctor at a polyclinic for a complete examination and treatment.

Hospitalization is considered mandatory when:

• unsuccessful actions of the ambulance staff and unresolved pain in the patient;
• a solitary kidney or a severe attack with pain in a transplanted donor organ;
• high body temperature, suspicion of infection;
• pregnancy.

In the hospital:

• continue to use antispasmodic drugs;
• use stronger painkillers;
• when pain persists, pararenal novocaine blockade is performed;
• prescribe symptomatic anti-vomiting agents;
• control blood pressure and the state of cardiac activity;
• when signs of inflammation appear, a course of antibiotic therapy is carried out;
• prescribed vitamins.

To determine further patient management tactics, the results of the examination are taken into account, the issue of planned surgical treatment is decided to install a stent and remove the stone, and indications for the use of ultrasound therapy.

Patients should understand that the removal of a stone after an attack does not mean a complete recovery. Changes in the exchange of salts in the body remain. This means that after some time another stone will form and the attack will repeat. Therefore, you should carefully consider the recommendations for diet, exercise, and medication.