Renal Colic - Causes, Symptoms, And Treatment.

Introduction:

Having a stone in the urinary tract causes acute renal colic, characterized by intense pain and discomfort. The stone can be found at any point along the tract from the kidneys to the urethra. Urinary calculi, also known as kidney stones, are the primary cause of acute renal colic. Urinary calculi are the major cause of acute renal colic when they are present in conjunction with renal calculi. The degree of pain is directly proportional to the degree of obstruction, not the size of the stone. Still, the size of the stone can be a reasonable predictor of the possibility of spontaneous passage of the stone in some cases.

What Is an Acute Renal Colic?

An acute renal colic is a severe form of sudden pain that often begins over the back and sides and extends anteriorly and inferiorly toward the groin or testicle. Renal colic is most frequently manifested by pain on the affected side of the body between the lower ribs and hip. This pain often radiates to the lower abdomen and groin area. It is commonly caused by a calculus obstructing the urinary tract and is frequently accompanied by nausea and vomiting.

What Are the Causes of Renal Colic?

Renal colic occurs when a stone becomes trapped in the urinary tract, most frequently in the ureter. The stone enlarges and compresses the area, producing excruciating pain. Additionally, reduced urine flow might result in irritation and elevated blood pressure. A kidney stone can be composed of a variety of chemicals and minerals. Since renal colic is caused due to stone obstruction, factors that increase the chances of stone formation itself increase the risk of renal colic.

What Increases the Risk of Renal Colic?

Stones form as a result of a variety of risk factors, including the following:

• Diet heavy in chemicals that induce stones to develop, such as oxalates and high proteins.

• Obesity.

• Dehydration is due to insufficient fluid intake or excessive fluid loss through sweating, vomiting, or diarrhea.

• Gastric bypass surgery increases your body's calcium and other stone-forming chemicals absorption.

• Compression of the ureteral lumen extrinsically by surgical clips, staples, and cancers.

• Musculoskeletal disorders.

• Metabolic abnormalities, hereditary diseases, hyperparathyroidism, and other conditions might cause your body to produce more stone-forming substances and urinary tract infections.

• Renal abscess, infarction, or venous thrombosis.

• Junction obstruction.

• Family or personal history of stones.

• Subcapsular spontaneous renal hematoma (Wunderlich syndrome).

• Retroperitoneal pathology (abscess, hematoma, or fibrosis).

What Are the Symptoms of Renal Colic?

Renal colic symptoms vary according to the size and location of the stone in the urinary tract. Specific small stones produce moderate renal colic and can be passed through the urine without causing severe pain. Larger stones can be quite painful, especially if they become lodged in the urinary tract and obstruct any minor openings. Susceptible sites include the ureters and the tubes that connect the kidney with the bladder. The significant symptoms of renal colic are:

• Severe pain on one side of your body, between your ribs and hip, or in your lower abdomen spreads to your back or groin.

• Nausea and vomiting.

Other symptoms caused due to urinary stones include:

• Pain during urination.

• Blood in your urine (Hematuria).

• Cloudy or smelly urine.

• Tiny pieces of renal stones in your urine.

• Urinary urgency.

• Urinating more or less than the usual amount.

• Fever and chills.

How Is Renal Colic Diagnosed?

History and physical examination, lab tests, and imaging studies are used to diagnose. The diagnostic tests are as follows:

• Urine Analysis- Urinalysis shows that about 85 percent of people who have stones have some microscopic or gross hematuria, but they should also be checked for signs of infection (e.g., white blood cells, bacteria). Urine concentration with a pH of more than 7.5 may be a sign of a bacterial infection that makes uric acid. Urine with a pH of less than 5.5 may be a sign of uric acid calculi.

• Computerized Tomography (CT Scan)- Unenhanced (or helical) CT is the best way to determine if you have a kidney infection. This is a quick way to find a stone. It gives information about the location and size of the stone and any hydroureter, hydronephrosis, or ureteral edema. It can also give information about possible other causes of pain (e.g., abdominal aortic aneurysm, malignancy). CT should be done in patients who have never had nephrolithiasis before. This will help the physician decide how to treat them.

• KUB (Kidney, Ureter, Bladder) X-Ray- It is best to use the KUB in cases where the CT scan is positive, and the exact location of the stone is known. A follow-up KUB can be used to track down stones that can be removed with lithotripsy (a procedure used to break kidney stones or other calculus by using ultrasound shock waves).

• Renal Sonography- If you have hydronephrosis, renal ultrasonography can help determine the condition. Like uric acid, it can also measure the resistive index and track larger renal stones. But it can often miss stones smaller than 5 mm in size and is not a perfect test to see ureteral calculi.

How Is Renal Colic Treated?

The treatment depends upon the underlying cause of renal colic. The treatment modalities include both drug therapy and surgical management in case of obstructions. Pain management is the primary motive while treating renal colic.

1. Pain Management Therapies- Analgesics (pain killers) and antiemetics should be used immediately. NSAIDs (non-steroidal anti-inflammatory drugs) and opiates are the first-choice treatments for pain.

• There are two ways NSAIDs help people who have kidney stones. First, NSAIDs cut down on producing arachidonic acid metabolites, which are linked to pain receptors. This reduces the pain caused by the swelling of the renal capsule. They also cause the different arterioles to contract to the glomerulus, which reduces glomerular filtration and decreases the hydrostatic pressure across the glomerulus, making it easier for blood to flow through the glomerulus.

• Most of the time, patients cannot take oral medications, so parenteral NSAIDs like Ketorolac (15 to 30 mg intravenously or intramuscularly) or Diclofenac (37.5 mg Intravenously) are used.

• The use of intravenous Lidocaine to treat renal colic has been proven successful. Over ten minutes, Lidocaine 120 mg in 100 ml of normal saline will be injected intravenously. This will help with the pain. It has been very effective for people who cannot get rid of their kidney stones with standard treatment. It usually starts working in three to five minutes.

2. Treatment for Obstructions- Even in asymptomatic patients with an obstructing stone, intervention is recommended after 30 days due to the increased risk of scarring and other consequences—the most common treatments in case of kidney stones or obstructions.

• Extracorporeal Shock Wave Lithotripsy (ESWL)- This therapy employs shock waves directed at your kidneys to shatter the stones into tiny fragments. Then the bits of stone are passed through urine.

• Percutaneous Nephrolithotomy- Typically, doctors do this surgery under general anesthesia and make a small incision in the back of the patient to gain access to the kidney and remove the stone with the aid of a lighted scope and small surgical instruments.

• Stent Placement- Occasionally, doctors will insert a small tube into a patient's ureter to relieve the obstruction and promote stone passage.

• Open Surgery- Some individuals who are unable to clear the stones may require open surgery. This surgery, however, requires a lengthier recovery period than other surgeries. Before considering open surgery, doctors will frequently attempt to extract or break up the stones to allow the patient to pass them.

3. Behavior Modification and Preventative Management-

• Increase fluid intake to optimize urine output, aiming for a daily output of 2 to 2.5 liters.

• Patients with calcium stones and elevated urine calcium levels should decrease sodium intake and aim for a daily calcium intake of 1000 mg to 1200 mg.

• Calcium stone patients with low urine citrate levels or uric acid stone patients with elevated urinary uric acid levels should increase their consumption of fruits and vegetables and lower their intake of non-dairy animal protein. They may benefit from supplementation with potassium citrate.

Conclusion:

While many stones pass naturally, they may nevertheless induce renal colic. Doctors frequently consider the optimum mix of medication and surgical therapy options to assist in the breakdown of bigger stones and their passage. Stones in the urinary tract can occasionally recur following successful treatment. Preventative interventions can help people avoid developing further stones and alleviate the symptoms of renal colic.