What is renal colic? How to use medication in clinical practice? Read this article to understand!

Renal colic is one of the most common acute abdominal diseases in clinic. It is caused by spasm of smooth muscle of renal pelvis and ureter or acute partial obstruction of lumen due to some causes. It is characterized by sudden onset of severe pain, which starts from the waist on the affected side and radiates along the ureter to the lower abdomen, groin and inner thigh, and can last for several minutes or tens of minutes, or even hours. The onset is often accompanied by symptoms such as nausea and vomiting, sweating, pale complexion, restlessness, etc., and severe cases may lead to shock.

0 1Typical clinical manifestations of renal colic

The typical clinical manifestations of acute renal colic are severe and unbearable pain in the lower back or upper abdomen, with paroxysmal attacks, accompanied by microscopic hematuria, nausea, and vomiting. During physical examination, the patient has obvious tenderness at the costovertebral angle. Typical renal colic often starts at the lower back and upper abdomen at the costovertebral angle, occasionally starting at the lower edge of the ribs, and radiating along the course of the ureter to the ipsilateral groin, inner thigh, male scrotum, or female labia majora. The degree of pain depends on the patient's pain threshold, sensitivity, speed and degree of pressure changes in the proximal ureter and renal pelvis of the obstruction, etc. Ureteral peristalsis, stone movement, and intermittent obstruction can all aggravate renal colic. The most obvious pain is often the site of obstruction. Renal colic manifests in 3 clinical stages:

(1 ) Acute phase

Typical attacks occur in the morning and evening, and can wake patients from sleep. When they occur during the day, the pain attacks are slow and insidious, often continuous, stable, and gradually worsening. In some patients, pain reaches its peak 30 minutes or more after onset.

(2 ) Duration

In typical cases, the pain peaks 1 to 2 hours after onset. Once the pain reaches its peak, it tends to persist until treatment or spontaneous remission. This period of the most pain is called the persistent phase of renal colic, which lasts 1 to 4 hours, but in some cases it can last up to 12 hours.

(3 ) Remission period

In the final stage, the pain decreases rapidly and the patient feels pain relief.

0 2 Clinical diagnosis of renal colic

Necessary imaging examinations include B-ultrasound examination, abdominal plain film, intravenous urography, non-enhanced spiral CT, etc. B-ultrasound examination has become the preferred screening method for diagnosing renal colic, mainly because it is not affected by the nature of stones, whether they are X-ray translucent or opaque stones, and can also be used to identify some other acute abdomens. In this process, it should be noted that painkillers should not be used repeatedly before renal colic is confirmed, otherwise it will affect the observation of the condition, delay diagnosis, and endanger the patient's life and health.

Differential diagnosis: Since renal colic is often accompanied by gastrointestinal symptoms such as nausea, vomiting, and abdominal distension, it is easy to be confused with acute abdomen. Therefore, the following common acute abdomens should be excluded during diagnosis: acute appendicitis, acute cholecystitis, and acute pancreatitis. Female patients should also exclude ovarian cyst pedicle torsion, ectopic pregnancy, acute salpingitis, etc.

0 3 Clinical treatment of renal colic

The primary task for patients with renal colic is to relieve pain and relieve the spasm of the smooth muscles of the renal pelvis and ureter. For patients with dehydration due to nausea and vomiting, intravenous access can be established to replenish water and electrolytes, while analgesia and antiemetic treatment can be given. Commonly used drugs include α-receptor blockers, nonsteroidal anti-inflammatory drugs, anticholinergic drugs, direct smooth muscle relaxants, etc.

Alpha-blockers

It can relieve ureteral smooth muscle spasm and renal colic, and reduce the recurrence of renal colic. It can be used to treat renal colic and play a role in expelling stones. However, it should be used with caution in patients with renal insufficiency.

Nonsteroidal anti-inflammatory drugs

It can block the synthesis of prostaglandins, reduce edema and inflammatory response, and reduce ureteral smooth muscle contraction to achieve analgesic effect. However, it should be noted that nonsteroidal anti-inflammatory drugs can reduce renal blood flow, cause renal damage, and cause adverse reactions such as sodium and water retention and renal insufficiency. It is necessary to monitor the patient's blood creatinine and endogenous creatinine clearance, and pay attention to the assessment of renal function. Patients with a history of kidney disease and severe atherosclerosis are at risk of acute renal failure and should use it with caution. Those at risk of nephrotoxicity should use nonsteroidal anti-inflammatory drugs with caution. Nonsteroidal anti-inflammatory drugs should be used with caution or prohibited in patients with renal dysfunction.

Anticholinergic drugs

For example, atropine and scopolamine block the M cholinergic receptors, inhibiting the binding of acetylcholine neurotransmitters to the receptors, thereby relieving smooth muscle spasms and achieving an antispasmodic and analgesic effect.

Opioids

Such as morphine, pethidine, etc., which mainly exert analgesic and sedative effects by binding to opioid receptors in the peripheral and central nervous systems. They can be used when non-steroidal anti-inflammatory drugs have poor analgesic effects.

In addition, surgical procedures such as shock wave lithotripsy and ureteroscopy can also be used for treatment.

In short, when renal colic occurs, it is necessary to make an early diagnosis and receive treatment as soon as possible, so as not to delay the disease, relieve pain, and slow the progression of the disease.