|Localization of pain caused by kidney stones|
Signs and symptoms
Renal colic typically begins in the flank and often radiates to below the ribs or the groin. It typically comes in waves due to ureteric peristalsis, but may be constant. It is often described as one of the most severe pains.
Although this condition can be very painful, kidney stones usually cause no permanent physical damage. The experience is said to be traumatizing due to pain, and the experience of passing blood, blood clots, and pieces of the stone. In most cases, people with renal colic are advised to drink an increased amount of water; in other instances, surgery may be needed. Preventive treatment can be instituted to minimize the likelihood of recurrence.
The diagnosis of renal colic is same as the diagnosis for the Renal calculus and Ureteric stones.
The renal colic must be differentiated from the following conditions:
- biliary colic and cholecystitis
- aortic and iliac aneurysms (in older patients with left-side pain, hypertension or atherosclerosis)
- interstitial: appendicitis, diverticulitis or peritonitis (in this case patients prefer to lie still rather than being restless)
- gynaecological: endometriosis, ovarian torsion and ectopic pregnancy
- testicular torsion
Most small stones are passed spontaneously and only pain management is required. Above 5 mm (0.20 in) the rate of spontaneous stone passage decreases. NSAIDs (non-steroidal anti-inflammatory drugs), such as diclofenac or ibuprofen, and antispasmodics like butylscopolamine are used. Although morphine may be administered to assist with emergency pain management, it is often not recommended as morphine is addictive and raises ureteral pressure, worsening the condition. Vomiting is also considered an important adverse effect of opioids, mainly with pethidine. Oral narcotic medications are also often used.
There is typically no antalgic position for the patient (lying down on the non-aching side and applying a hot bottle or towel to the area affected may help). Larger stones may require surgical intervention for their removal, such as shockwave lithotripsy, ureteroscopy or percutaneous nephrolithotomy. Patients can also be treated with alpha blockers in cases where the stone is located in the ureter.
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