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Oganes E. Dilanyan
Urologist, MD, PhD

Renal Colic

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In this article

Renal colic manifests as extremely uncomfortable, debilitating pain that comes in waves and is located in the lumbar region. It is caused by a ureter blockage and subsequent stretching of the renal collecting system of the kidney. Kidney colic most often happens in the presence of kidney stone disease but can also be caused by other conditions such as ureter tumour, blockage with a blood clot or hydronephrosis caused by a congenital blood vessel abnormality. 

If you are reading this article while experiencing a renal colic stop right now. Ring your doctor. Ring me, any other doctor, call an ambulance – anything. 

“Men experiencing a renal colic start appreciating women more as it is similar to labour pain.”

First aid for renal colic

Renal colic is a condition that requires urgent professional help and admission to hospital and not careful studying of information and searching for the ways of self-treatment.  
How to get relief from pain when experiencing a renal colic? Don’t even try. Never take any medication or try to self-treat because this can be dangerous! In the vast majority of cases self-treatment of a renal colic at home will lead to purulent pyelonephritis which can be fatal due to the development of renal carbuncles, abscess and sepsis. 

Renal colic is an acute episode of very sharp pain in the lumbar region which is caused by sudden disruption of urinary flow from the kidney. This pain often radiates to the groin and the patient tries to assume a comfortable position but can’t really find one.

One might think: and so what? But a brief dry description of the renal colic does not quite demonstrate the danger of this condition. Think about it, the pain that can present as almost identical to appendicitis often can lead to developing acute purulent pyelonephritis which in some case calls for kidney removal.

Please do not self-treat as renal colic has the ability to cripple.

Diagnosis of renal colic in men and women

Most often the pain develops as a result of the ureter blockage in the presence of kidney stones. Less often renal colic can be the result of  hydronephrosis, and sometimes the ureter can get blocked by a blood clot or a tumour fragment  in the presence of renal cancer.
In all of the abоve cases the urine cannot leave the renal pelvis and the latter stretches in turn irritating the nerve endings. Sharp and severe pain follows. Diagnosis of renal colic always requires a face to face consultation with a urologist. It is impossible to diagnose renal colic pain over the phone or over the internet as it is impossible to remotely distinguish it from radicular pain or, which is even worse, acute appendicitis pain.
The proper diagnostic process needs to include:

  • Examination of the patient
  • Palpation of the abdomen and the kidneys
  • Kidney ultrasound as a way to accurately determine the stretching of renal pelvis
  • General blood test, general urine test and urine culture
  • General and excretory urography which is an x-ray method and helps to see the kidney stones and access how the kidneys are functioning.  
  • Often a CT scan is performed but this is done as part of kidney stone treatment and allows us to determine the density of the stone, it’s size and it’s exact.   

Renal colic treatment

There is no such thing as “renal colic treatment” because acute renal colic itself is a symptom of a kidney problem. However this symptom almost always occurs when urine flow from the kidney is blocked.  That is why when we talk about treatment we talk about restoring the flow of urine. 
First and the most common way of treatment is medication and conservative approach. This is aimed at allowing the stone pass naturally. The patient receives painkillers and antispasmodic medication but it is important that they remain under the doctor’s supervision. This often raises the question: would it not be easier to just look up the names of the medications required and self-treat? Unfortunately many people do exactly this and as a result end up in hospital with acute purulent pyelonephritis which develops as a result of infection starting in the stagnating urine. During treatment in the clinic the doctor supervises the process and as soon as the first symptoms of pyelonephritis appear active measures such as kidney stenting or nephrostomy are undertaken to normalise urine outflow.
Kidney stenting in the presence of renal colic when a stent which consists of a thin hollow tube which allows urine to flow from the kidney into the bladder is placed into the ureter.
Percutaneous nephrostomy. In some cases where apart from urine flow blockage there is also a presence of infection and purulent inflammation of the kidney it is not possible to place a stent internally. In this case nephrostomy is performed and a tube is inserted directly into the kidney under Ultrasound control. This allows to drain puss from the kidney and allows to plan the removal of the stone from the ureter in a way that does not endanger the patient’s life.
So in the vast majority of cases in order to treat this condition the doctors must restore the flow of urine using one of the above methods. Should one try and self-treat renal colic at home? Never! There is only one correct course of action: go see a doctor. Urgently.

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