An attack of renal colic is characterized by sharp, sudden pain in the kidneys, right or left. Kidney or urinary stones are the main cause. What are the signs ? How to treat it? When is it an emergency?
An attack of renal colic reveals the presence of stones in the kidneys and/or urinary tract. Having urinary stones is more and more frequent especially between 40 and 60 years old. Renal colic is very painful. According to the most recent figures published by the HASrenal colic represents in France approximately 1 to 2% of admissions to emergency departments. In 75 to 80% of cases it is of lithiasic origin (stones). THE recidivism rate is then significant: approximately 15% at one year and 50% at 10 years. Renal colic is a medico-surgical emergency whose diagnosis is confirmed by radiological examinations. Symptoms, causes, treatments. Everything you need to know about renal colic.
Definition: what is renal colic?
There renal colic refers to the pain felt when urine cannot flow normally from the kidney to the bladder. Most often, a calculation is responsible for obstruction of the urinary tract; it is mainly composed of calcium oxalate. The urinary system is made up of two kidneys, two ureters, a bladder and a urethra. Urine is made from blood filtered from the kidneys. This is then transported out of the kidneys by two small tubes called ureters, to the bladder to be stored there. Finally at the time of urination, the emptying of the urine contained in the bladder will be done by a last conduit called the urethra, ending in the urinary meatus, the orifice through which it will be excreted from the body.
What are the symptoms of a renal colic attack?
There pain felt is particularly intense, similar to a “stab” and lasts from several minutes to several hours. It is located at the level of the right or left lumbar fossa (where the kidneys)) and can radiate to the groin and genitals. No position seems to relieve the pain. Of the nausea, vomiting, bloating, cessation of transit, difficulty urinating and the presence of blood in the urine can complete the list of symptoms.
What causes renal colic attacks?
The main cause of renal colic is presence of a stone (we speak of urolithiasis) in one of the two ureters, the channels through which urine travels from the kidney to the bladder. The passage of urine being more difficult, if not impossible, the pressure increases in the excretory tract and leads to intense pain. Stone pathology is common, especially between the ages of 40 and 60, and more particularly in men. In very rare cases, renal colic may be due to a malformation of a urinary tract. Namely that recurrences are frequent when one has already suffered an attack of renal colic.
A urinalysis can usually detect the presence of blood (because the calculation irritates the urinary tract when it moves) and to reveal a possible urinary tract infection. A ultrasound can also highlight calculations and dilation of the urinary tract upstream of the obstacle. Complementary examinations (X-ray or scanner) can sometimes be prescribed to eliminate other potential causes of pain (in the intestinal tract for example).
What treatment for renal colic?
The smallest stones (less than 5 mm) are generally expelled spontaneously: they move, then end up reaching the bladder from where they are evacuated with the urine. In this case “medical treatment is mainly based on monitoring the spontaneous expulsion of the stone and the application of lifestyle and dietary rules” specifies the High Authority of Health.
In pregnant women, corticosteroids may be indicated
There taking analgesics or antispasmodics can relieve pain until their complete elimination. Morphine analgesics, systemically, can be administered immediately or secondarily in the event of intense pain or in the event of contraindications to NSAIDs. At the pregnant woman, corticosteroids may be indicated. If the calculations are not evacuated naturally, a specific treatment can be envisaged (ureteral catheter, stone fragmentation by laser or shock waves). Prevention, to avoid recurrences, it is recommended to drink at least two liters of water a day and limit the consumption of foods rich in purines (organ meats or sausages), salt and oxalate (chocolate, dried fruit, spinach, sorrel, rhubarb, tea). In 2017, the HAS pointed out that “less than 8% of renal colic attacks are hospitalized due to complications”.
What to do when a child has renal colic?
The signs of renal colic are more frank in children after 10 years and found in the majority of cases. According to the recommendations published by the High Authority of Health in 2021, in the event of renal colic, the doctor will initially take care of the child pain (with some anti-inflammatories, spasmolytics, paracetamol). In case of uncontrolled pain or signs of severity, he will refer the child to a pediatric emergency department to perform a kidney ultrasound and discuss the management according to the result of the latter, in connection with the teams of nephrologists and pediatric urologists. Secondly, it is imperative to refer the patient to a pediatric nephrologist. A hospitalization may be necessary in the event of acute dilation of the urinary tract, crisis not relieved by conventional measures, or elements evoking an infectious complication (fever, pyonephrosis).
When to go to the emergency room for renal colic?
If the renal colic is accompanied by fever, it can be a kidney infection : in this case, an emergency medical consultation is necessary. Similarly, the complete cessation of the emission of urine (anuria) is an emergency. Finally, the pregnant women and people suffering from chronic kidney disease should see a doctor promptly.
Content validated by Dr. Richard Handschuh, general practitioner.
Sources:
– First-line interventional treatments for urinary stones, May 2017, HAS