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Renal colic

Renal colic – the bad painful attack caused by sudden violation of a passage of urine, increase in vnutrilokhanochny pressure and renal ischemia. Renal colic is characterized by the expressed skhvatkoobrazny waist pains extending on the course of a mochetochnik down, the speeded-up and painful urination, nausea and vomiting, psychomotor excitement. Knocking over of an attack of renal colic is carried out by means of local heat, introduction of spazmolitik and analgetics (up to narcotic), novokainovy blockade. For definition of the reason of renal colic the urine research, intravenous urography, a hromotsistoskopiya, ultrasonography, KT of kidneys is conducted.

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Renal colic

Renal colic can complicate a current of a number of diseases of urinary tract. In urology renal colic is regarded as the urgentny state demanding the fastest removal of an acute pain and normalization of functioning of a kidney.

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Reasons of renal colic

Development of renal colic is connected with sudden violation of removal of urine from a kidney owing to internal obstruction or an external sdavleniye of urinary tract. This state is followed by reflex spastic reduction of muscles of a mochetochnik, increase in hydrostatic pressure in a lokhanka, a venous staz and ischemia of a kidney, hypostasis of a parenchyma and restretching of the fibrous capsule of a kidney. Owing to irritation of sensitive receptors the sudden and expressed pain syndrome – renal colic also develops.

The mechanical obstacles breaking an urine passage from a kidney lokhanka or a mochetochnik can act as immediate causes of renal colic. In most cases (57,5%) renal colic arises at infringement of a concrement in any department of a mochetochnik at an urolithic disease. Sometimes the obturation of a mochetochnik is caused by clots of slime or pus at pyelonephritis, the kazeozny masses or the torn-away nekrotizirovanny nipples at kidney tuberculosis. Besides, the excess can be the reason of renal colic or pereknut a mochetochnik at a nefroptoza, a kidney allotopia, striktura of a mochetochnik. An external sdavleniye of uric ways tumors of kidneys (a papillary adenocarcinoma, etc.) often cause, a mochetochnik, a prostate gland (prostate adenoma, a prostate cancer); zabryushinny and subkapsulyarny post-traumatic hematomas (including, after a remote lithotripsy).

Other group of the reasons promoting development of renal colic is connected with inflammatory or stagnant diseases of uric ways. So, bad painful attacks quite often arise at a gidronefroza, sharp segmentary hypostasis mucous at a periureterita, an uretrita, prostatitis, a flebostaza in venous system of a small pelvis.

The renal colic caused by sharp vascular diseases of uric ways arises at thrombosis of renal veins, an embolism and a heart attack of a kidney. Violations of an urodinamika in the top uric ways meet development of renal colic at their congenital anomalies (an akhalaziya, dyskinesia, a megakalikoza, a spongy kidney, etc.).

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Symptoms of renal colic

Sudden, intensive, skhvatkoobrazny pain in lumbar area or a costal and vertebral corner is a classical sign of renal colic. The painful attack can develop at night, in the period of a dream; sometimes patients connect the beginning of renal colic with physical activity, jolty driving, long walking, reception of diuretic drugs or large volume of liquid. From a waist pain can extend to the mezogastralny, podvzdoshny area, a hip, a rectum; at men – in a penis and a scrotum, at women – in vulvar lips and a crotch.

The painful attack at renal colic can last from 3rd to 18 hours; at the same time intensity of pain, its localization and irradiation can change. During renal colic patients are uneasy, rush about, do not find the situation relieving pain.

At the time of renal colic frequent desires on an urination, further - an oliguriya or an anury, gripes in an urethra, dryness in a mouth, vomiting, tenezma, a meteorizm develop. Against the background of renal colic moderate hypertensia, tachycardia are noted, subfebrilitt, oznoba. Severe pain at renal colic can cause development of a state of shock (hypotonia, pallor of integuments, bradycardia, cold sweat). After the termination of renal colic the considerable volume of urine in which it is found micro or a makrogematuriya is usually allocated.

Renal colic always should be differentiated from other states which are followed by abdominal and lumbar pains - an acute appendicitis, sharp pancreatitis, cholecystitis, thrombosis of mezenterialny vessels, aneurism of an aorta, extra-uterine pregnancy, a perekrut of a leg of a cyst of an ovary, probodny stomach ulcer, an epididimoorkhit, a perekrut of a small egg, hernia of an intervertebral disk, intercostal neuralgia and so forth.

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Diagnosis of renal colic

At recognition of renal colic are guided by the anamnesis, data of an objective picture and tool researches. During renal colic the corresponding half of lumbar area is painful at a palpation, the pokolachivaniye symptom on a costal arch – is sharply positive. The urine research after subsiding of a painful attack allows to find fresh erythrocytes or clots of blood, protein, salts, leukocytes, an epithelium.

The survey X-ray analysis of an abdominal cavity allows to exclude sharp abdominal pathology. Besides, on roentgenograms and urogramma more dense shadow of the affected kidney and "a depression aura" in the field of okolopochechny fabrics at their hypostasis can come to light intestines. Carrying out intravenous urography on change of contours of cups and lokhanka, to a kidney smeshchayemost, character of a bend of a mochetochnik, etc. to signs allows to establish the reason of renal colic (, a stone of a mochetochnik, , , etc.).

Hromotsistoskopiya led to time of an attack of renal colic finds delay or lack of allocation of an indigokarmin from the blocked mochetochnik, sometimes - hypostasis, hemorrhage or the stone restrained in the mouth of a mochetochnik. For studying of a condition of urinary tract ultrasonography of kidneys and a bladder is carried out; for the purpose of an exception of "a sharp stomach" - ultrasonography of an abdominal cavity and a small pelvis. Tomographic researches (KT of kidneys, MRT) allow to establish the reason of the developed renal colic.

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Treatment of renal colic

Knocking over of renal colic is begun with local thermal procedures, (applyings of a warm hot-water bottle to a waist or a stomach, a sedentary bathtub with the water temperature of 37 — 39 °C). For removal of pain, a spasm of uric ways and restoration of a passage of urine introduction of anesthetics and spazmolitichesky medicines is made (metamizol of sodium, trimeperidine, atropine, a drotaverin or a platifillin intramuscularly).

It is expedient to try to remove a prolonged attack of renal colic by means of novokainovy blockade of a seed kanatik or a round uterine ligament of a uterus on the party of defeat, intra pelvic blockade, paravertebralny irrigation of area of a waist chlorethyl. In a sharp phase acupuncture and an elektropunktura are widely used. At small concrements in a mochetochnik physiotherapy – a diadinamoterapiya, OUSE therapy, vibration therapy, etc. is carried out.

At the renal colic proceeding against the background of sharp pyelonephritis with high rise in temperature, holding thermal procedures is contraindicated. In case of unsuccessfulness of the undertaken conservative measures of the patient hospitalize in an urological hospital where the kateterization or stenting of a mochetochnik, punktsionny imposing of a nefrostoma or surgical treatment is made.

Further inspection at the urologist (nephrologist) and planned treatment of the disease which caused development of renal colic is shown.

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Forecast and prevention of renal colic

Timely knocking over and elimination of the reasons leading to development of renal colic allows to exclude a possibility of a recurrence. At long obstruction of uric ways there can be irreversible injuries of a kidney. Accession of an infection can lead to development of secondary pyelonephritis, an urosepsis, bakteriyemichesky shock.

The prevention of developing of renal colic consists in an exception of all possible risk factors, first of all - an urolithic disease.

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Renal colic - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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