Renal colic

Description:

Renal colic is the strong attack of pain in a waist caused by sharp disturbance of outflow of urine from a kidney and disturbance of blood circulation in it. Pain results from restretching of a renal pelvis under pressure of not flowing urine.

Symptoms of Renal colic:

The attack of renal colic begins most often suddenly after jolty driving, physical tension, but can arise also in a condition of absolute rest (night). Patients complain of the severe pristupoobrazny pain in lumbar area irradiating to the inguinal area, generative organs, a hip. Pain has the cutting character, periodically becomes aggravated. Patients behave uneasily, rush about in a bed in search of the situation relieving pain. Pain is followed by increase of desires to an urination and gripes in an urethra. In urine quite often find a gross hematuria, it is frequent - a microhematuria. Complaints to nausea and vomiting, repeated desires on defecation are frequent. Owing to severe pain the depressed case (a pale face, cold sweat, low and frequent pulse) can develop. Intensity of renal colic depends on the factor which caused it and a condition of a nervous system of the patient. Some of the given signs can be erased or even to be absent.

Frequency of identification of separate symptoms and change of laboratory indicators at renal gripes following:

  1. A pain syndrome - 100%:
        1.bol in lumbar area - 93%;
        2.bol in belly area - 7%.
  2. A positive symptom of effleurage on the XII edge - 87,8%:
        1.rezko positive - 65,3%;
        2.slabopolozhitelny - 22,5%.
  3. Pain in lumbar area without irradiation - 18%.
  4. Pain with typical irradiation - 36%.
  5. Pain with atypical irradiation - 46%:
        1.v an abdominal cavity - 39%;
        2.v a chest cavity and a shoulder - 7%.
  6. A dysuria - 45,4%.
  7. Nausea - 56%.
  8. Vomiting - 41%.
  9. Increase in arterial pressure upon 10-30-50 mm hg - 92,6%, increase in temporal arterial pressure - 80%.
  10. Fervescence to 38 °C (within 2 - 3 days) - 38%.
  11. A hamaturia - 23%, in the presence of stones in ureters - 41%.
  12. A leukocyturia - 40,2%.
  13. A leukocytosis 7×109/л - 14×10э/л - 47%.
  14. Increase in SOE (to 20-50 mm/h).
  15. Increase in level of urea in blood - 17,8%.

Reasons of Renal colic:

Renal colic can be caused:

  1.ostro the arising mechanical obstacle breaking an urine passage;
  2.vospalitelnym process in pyelocaliceal system;
  3.gemodinamicheskimi the disturbances in a kidney causing ischemia, arterial and venous hypertension, thromboembolic processes in renal vessels;
  4.allergicheskimi the reactive phenomena in a mucous membrane of upper uric ways;
  5.spasticheskimi the phenomena in upper uric ways arising reflex at cholecystitis, appendicitis, a myocardial infarction during a menstrual cycle, etc.

Can be the reasons of renal colic: an urolithiasis (at 57,5% of patients), disturbance of mineral exchange (at 14,5%), pyelonephritis (at 12%), a nephroptosis (at 10%), a hydronephrosis (at 2%), anomalies of development (at 3,5%), tumors of kidneys and a pelvis (at 1,5%), post-beam strictures of ureters (at 1%), prostate diseases (at 2%), a periureteritis (at 0,5%), tuberculosis of urinogenital system, germination by a tumor of a bladder of the mouth of an ureter, leukoses. Often it is not possible to establish the reason of renal colic (to 38% of cases).

In a kidney on the party of defeat intrapelvic hypertensia to 150 mm of water column at norm of 15 mm of water column develops, forniksa are damaged. There are fornikalny refluxes which cause an urine ekstravazation out of limits of pyelocaliceal system in a renal sine, perinephric cellulose. Further it leads to a pedunkulit, a sclerosis of a fatty tissue at hiluses renalis, wine renal hypertensia. Besides, there are a vasospasm of a kidney and its ischemia, venous and lymphatic стаз in it, glomerular filtering and an effective renal plazmotok decrease. In a contralateral kidney glomerular filtering and an effective renal plazmotok also decrease, the diuresis is oppressed.

Treatment of Renal colic:

To begin treatment at home at high temperature of a body in doubtful cases, in the presence of a hamaturia inadmissibly. It is possible to enter spasmolysants only. In a hospital appoint spasmolysants (most often Nospanum, Atropini sulfas, Platyphyllinum hydrotartrate, a papaverine a hydrochloride, Halidorum, спазмоверин, Spasmolytinum, an Euphyllinum, etc.), anesthetics (Baralginum, максиган, триган E, трамадол, analginum, fentanyl, novocaine, Droperidolum, Promedolum, etc.), various lytic mixes which drive intramusculary, and in hard cases and intravenously. Widely apply thermal procedures - a hot-water bottle, a sack with sand, sedentary bathtubs (water temperature of 38 - 39 °C, 15-20 min.), lying bathtubs without covering water of area of heart (water temperature of 37 - 38 °C, 15 - 20 min). Thermal procedures are contraindicated to elderly people, with cardiovascular insufficiency, macro - or microhematurias, tumors of any localization. Apply novocainic blockade less often (a seed cord, perinephric, intra pelvic, intradermal, etc.). Acupuncture, an electropuncture were widely adopted. At inefficiency of the specified actions apply catheterization of an ureter or internal stenting by a catheter stent. In the presence of small concrements in an ureter widely apply various physiotherapeutic methods of treatment (diadynamic currents, ultrasonic therapy, sound stimulation, vibration therapy). At unsuccessfulness of conservative therapy it is necessary to resort to surgical treatment. Indications to urgent operation are:

  1.pochechnaya colic with development of acute purulent pyelonephritis;
  2.obturatsionnaya anury;
  3.pochechnaya коликя at the only kidney;
  4.nalichiye large occlusive stone.