Renal Colic

Renal colic is a very severe pain that can present suddenly and without warning. It is a sharp pain in the lower back that radiates into the groin. Colic literally means pain and it is due to the renal or kidney problems that is why it is known as renal colic.

Cause

1. Acute retentions of urine- it may be due to renal stones, and benign enlargement of prostate.
2. A urinary tract infection may also lead to sudden pain in the loin or renal colic quiet often. Dehydration may be one factor causing renal colic.

Epidemiology

• The lifetime risk for stones is said to be about 10% for men with a male-to-female ratio of 3:1.
• A family history of stones doubles the risk but most patients with renal colic do not have a family history.
• The peak age of onset is 20 to 40 and if stones present significantly outside this age group there is a greater chance of an underlying metabolic abnormality.
• The risk of stones is higher in higher socio-economic groups.

Symptoms

1. Pain -The pain typically begins in the loin region and often radiates to the lower abdomen or the groin. The pain is often colicky (comes in waves) due to ureteric peristalsis. The pain may last from few minutes to several hours and till the pain is there that leaves the patient in rolling in the bed and writhing in agony, but may be constant. Retention of urine may or may not be present depending upon the cause. It may come in two varieties: dull and acute; the acute variation is particularly unpleasant and is often described as one of the strongest pain sensations felt by humans.In lower obstructions, males may get pain in the genitals.
2. Urinary complaints- difficulty in passing urine, scanty urination or haematuria.

Physical examination

1. Affected area is usually tender.
2. There may be pain in testis but testis are not tender.
3. Increase body temperature.
4. Low blood pressure.

Risk factors

Predisposing factors to renal stones are many but can be summed up as follows:

• Excessive calcium in the urine
• Excessive oxalate in the urine
• Excessive excretion of uric acid, with or without clinical gout
• Deficiency of citrate in the urine
• Drugs, especially thiazide diuretics
• People with urinary stasis due to anatomical abnormalities of the pelvi-calyceal system.

Investigations

1. Urinalysis- including physical, chemical and microscopic examination.
2. Estimation of urine pH and specific gravity.
3. X-ray of KUB region.
4. Ultrasound of KUB region.
5. Renal function test.

Management