Renal colic manifests itself as sharp, sudden pain in the kidneys. Kidney or urinary stones are the main cause.
An attack of renal colic reveals the presence of stones in the kidneys and/or urinary tract. Having urinary stones is common, especially between 40 and 60 years old which does not prevent renal colic from being very painful. According to figures published by the HASit represents approximately 1 to 2% of entries into French emergency services. In 75 to 80% of cases it is of lithiasic origin (stones). THE recidivism rate is then significant: around 15% at one year and 50% at 10 years.
Definition: what is renal colic?
There renal colic refers to the pain felt when urine cannot flow normally from the kidney to the bladder. The urinary system is made up of two kidneys, two ureters, a bladder and a urethra. Urine is produced from blood filtered through the kidneys. This is then transported out of the kidneys through two small tubes called ureters, to the bladder to be stored there. At the time of urination, the urine contained in the bladder is drained through a final conduit called the urethra, ending in the urinary meatus, the orifice through which it is excreted from the body. “Renal colic is a tension in the renal cavities due to an obstacle, often an acute obstacle. Most often, a stone which will block the ureter and put tension on the kidney cavities” says Dr Nadia Abid, urological surgeon.
What are the symptoms of an attack of renal colic?
There pain felt is particularly intense, similar to a “stab” And lasts from several minutes to a few hours. “Patients describe pain worse than childbirth and without any analgesic position (relieving pain)” emphasizes Dr. Abid. The pain is located at the level of the right or left lumbar fossa (where the kidneys) and littlet radiate to the groin and genitals. “Of the nausea, abdominal pain, bloating, cessation of bowel movements, frequent urge to urinate and blood in the urine” adds our interlocutor.
How long does renal colic last?
It can last 10-15 minutes or several hours. “We will continue to have pain as long as the stone completely obstructs the ureter and the kidney cannot empty itself.. The patient urinates normally thanks to the second kidney but the urine is blocked in the other kidney which will dilate” explains the urologist. It is possible to have several attacks in a row days apart. A stone can take up to 2 months to eliminate.
What causes renal colic attacks?
The most common cause of renal colic is presence of a stone (we speak of urolithiasis) formed in the kidney and which passes into one of the two ureters, causing the crisis. As the passage of urine is more difficult, if not impossible, the pressure increases in the excretory pathways and causes intense pain. “In very rare cases, renal colic can be due to a malformation of a urinary tract, a clot in the blood or tissues that become necrotic in the kidney following an infection” notes Dr. Abid. Note that recurrences are common when you have already suffered an attack of renal colic.
A Urine analysis generally detects the presence of blood (because the stone irritates the urinary tract when it moves) and reveal a possible urinary infection. THE to scan shows the consequences of renal colic and calculus. A ultrasound or a x-ray can also highlight stones and kidney enlargement.
What treatment for renal colic?
► The smallest stones (less than 5 mm) are usually expelled spontaneously : they move, then eventually reach the bladder where they are evacuated with urine. “A stone of less than 4mm has more than an 80% chance of passing, a stone of 5mm has around a 70% chance. In this case, a medical treatment based on anti-inflammatories (ketoprofen) or possibly alpha-blockers (knowing that they do not have marketing authorization for this indication in France but can be prescribed) will suffice. We will do another scan a month later to check that the calculation has started correctly.“explains Dr. Abid. taking analgesics or antispasmodics helps relieve pain until their complete elimination. Morphine analgesics, systemically, can be administered immediately or secondarily in cases of severe pain or in cases of contraindications to NSAIDs. At the pregnant woman, corticosteroids may be indicated.
“We are not removing the dairy products we need to be healthy”
► If the size of the stone is closer to 8mm, the urologist will offer semi-emergency treatment via extracorporeal lithotripsy, a method which involves using shock waves to transform the stone into sand so that it evacuates. We can also consider endoscopic surgery with pliers to remove it. “If you have areas at risk, obstructive pyelonephritis or pain that does not respond to analgesic treatment, you can place a “double J” urinary catheter (a small tube that loops in the kidney and in the bladder like a straw allowing urine to to evacuate and short-circuit the calculation). But the tube is not always very well supported because it remains a foreign body so it is never the first-line treatment” explains the urologist.
What foods to avoid in case of renal colitis?
You should definitely not drink in cases of renal colic because you fill the kidney even more, you put it under more tension and you risk increasing the pain. It is therefore necessary to put in place a fluid restriction during the crisis. Prevention, to avoid recurrences, it is recommended to drink at least two liters of water per day and limit the consumption of foods high in purines (offal or cold meats), in salt and oxalate (chocolate, dried fruits, spinach, sorrel, rhubarb, tea). “On the other hand, we certainly do not remove the dairy products that we need to be in good health. Deficiencies can cause other types of stones” warns the urologist.
What to do when a child has renal colic?
The signs of renal colic are more obvious in children after 10 years of age and found in the majority of cases. According to the recommendations published by the High Authority of Healthin the event of renal colic, the doctor will initially take care of the child’s pain (with some anti-inflammatories, spasmolytics, paracetamol). In the event of uncontrolled pain or signs of seriousness, he will refer the child to a pediatric emergency department to perform a renal ultrasound. Secondly, it is imperative to refer the patient to a nephropediatrician. A hospitalization may be necessary in the event of acute dilation of the urinary tract, a crisis not calmed by traditional measures, or elements suggesting an infectious complication (fever, pyonephrosis).
When to go to the emergency room for renal colic?
If the renal colic is accompanied by fever, it may be a kidney infection : in this case, emergency medical consultation is necessary. Likewise, the complete cessation of the emission of urine (anuria) is an emergency. Finally, the pregnant women and people suffering from chronic kidney disease should consult a doctor promptly.
Thanks to Dr Nadia Abid, urological surgeon.