Renal colic is an emergency. Emergency care in case of an attack of renal colic, algorithm of actions. Emergency care when symptoms of renal colic appear

Renal colic is a complex symptom complex, including reactions of all body systems and manifested by pain, the causes of which can be different. It usually occurs with acute obstruction of urine outflow due to obstruction of the upper urinary tract a calculus, a blood clot, mucus or pus, a conglomerate of uric salts, caseous masses, rejected necrotic papillae, as a result of kinking of the ureter or spasm of the renal pelvis, ureter. Renal colic can be observed with functional disorders of the upper urinary tract, circulatory disorders in the kidneys and ureters, during treatment with glucocorticoids, with allergic and other diseases.

Pre-hospital assistance:

1. Heat in the form of heating pads, heated sand, hot baths (temperature 40-50 °C).

2. Intramuscular injection of one of the antispasmodics (atropine 0.1% solution 1 ml, platiphylline 0.2% solution 1 ml, papaverine 2% solution 2 ml, no-spa 2% solution 2 ml, magnesium sulfate 25% solution 10 ml) or painkillers (analgin 50% solution 1 ml, promedol 1% solution 1 ml, omnopon 2% solution 1 ml).

3. The use of narcotic analgesics for renal colic permissible only if organ diseases are excluded abdominal cavity in cases where pain is not relieved by other medications.

4. Drugs belonging to the group of antispasmodic analgesics (baralgin, spazgan, trigan, maxigan) are widely used. One of the best drugs for pain relief should be considered baralgin (5 ml), which is most effective when administered intravenously. The drug is contraindicated in patients with an allergic reaction to analgesics.

5. After emergency care is provided, the patient is urgently hospitalized in the urological or surgical department, where the diagnosis is clarified and adequate treatment is provided.

Assistance at the hospital stage:

1. To relieve renal colic, it is used intravenously

— Platyfillin (0.2% 1 ml) + promedol (1% 1 ml) + diphenhydramine (1% 1 ml).

— Papaverine (2% 2 ml) + promedol (1% 1 ml) + analgin (50% 1 ml) + pentamin (5% 0.5-1 ml).

— Halidor (2.5% 2 ml) + papaverine (2% 2 ml) + diphenhydramine (1% 1 ml) + aminazine (2.5% 1 ml).

— No-spa (2% 2 ml) + pipolfen (2.5% 2 ml).

2. In order to eliminate an acute pain attack, intravenous administration of fentanyl (0.005% solution 2 ml) is used in combination with droperidol (0.25% solution 2 ml) and no-shpa (2% solution 2 ml). Usually after injection the pain disappears within a few minutes.

3. An effective remedy relief of renal colic is the intravenous administration of prostaglandin blockers (indomethacin, voltaren, diclofenac sodium at a dose of 50 mg), which reduce diuresis by 50%, which leads to the disappearance of pain.

4. For therapeutic, as well as differential diagnostic purposes, it is possible to block the spermatic cord in men or the round ligament of the uterus in women according to Lorin-Epstein:

- the skin of the groin area on the sore side is treated with alcohol, iodine and the index finger of the left hand determines the external opening of the inguinal canal and the spermatic cord emerging from it;

- the spermatic cord is fixed between the index and thumb of the left hand, and 5-8 ml of a 0.5% novocaine solution is injected subcutaneously with the right;

- the needle is advanced to the spermatic cord and 50 ml of 0.25% novocaine solution is injected into it and the surrounding tissues;

- in women, the same amount of novocaine is injected into subcutaneous tissue at the site where the round ligament of the uterus exits the external opening of the inguinal canal.

After novocaine blockade, renal colic subsides within 15-20 minutes; at acute diseases abdominal pain does not decrease.

5. Sometimes paravertebral blockade with chlorethyl is used to relieve an attack of renal colic. To do this, irrigate the skin of the paravertebral region from T11 to L3 on the affected side with chlorethyl until it turns white. Paravertebral blockade with chlorethyl on the right allows for differential diagnosis between renal colic and acute appendicitis. In case of renal colic, the pain disappears completely or decreases; in acute appendicitis, the pain persists and its intensity does not decrease.

6. For the purpose of preventing repeated attacks of renal colic and as an additional means of eliminating acute pain syndrome Patented combination drugs are used: cystenal, urolesan, pinabine, enatin, olimethine.

Providing timely emergency care to a patient with renal colic contributes to the rapid restoration of impaired organ functions and prevents the occurrence of severe complications. Each patient, after eliminating renal colic, needs a detailed urological examination.

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Causes of renal colic

Renal colic is an acute, paroxysmal pain radiating to the lower back. Sometimes it is felt in the ureters (along the path of urine) or in the lower abdomen. Most often, the pain is localized on one side.

Pain syndrome during renal colic is caused by stretching of the renal pelvis. This pain is considered one of the most acute and intense.

Renal spasm is a manifestation of the following pathologies in the body:

urolithiasis disease;
renal tuberculosis;
exacerbation of pyelonephritis;
the presence of diseases that cause problems with metabolism ( diabetes, gout).

Sometimes an attack of renal colic occurs due to previous injuries or the consequences of surgery. In almost half of the cases, the cause of the spasms cannot be determined.

Symptoms and first aid

Colic attacks are always sudden and very painful. In such a situation, first aid will help to significantly alleviate the patient’s suffering. Before taking any action, you need to understand the symptoms accompanying the attack.

Main signs of colic

Renal colic occurs in both adults and children. This condition has no age or gender restrictions. The main symptom is acute, cramping pain.

Usually the pain is localized in the lower back or to the side of the kidney. When colic is caused by urolithiasis, discomfort may be felt in different places. This is caused by the movement of the stone along the ureter. Men often have painful sensations in the groin, area of the testicles and penis, while in women the pain is felt in the perineum and labia. Children usually complain of pain around the navel.

The pain is accompanied by the following symptoms:

the patient is restless, trying to take the most comfortable body position;
strong thirst;
pale skin;
high temperature, chills;
false urge to urinate;
cutting pain when passing urine;
difficulty in the outflow of urine.

If the pain intensity is very high, the patient may experience a state of shock, including loss of consciousness. The skin becomes covered with cold, sticky sweat, and blood pressure rises sharply.

Attention! If a patient experiences an attack of pain in the kidneys, you should immediately call a doctor. Renal colic can last from several hours to a day.

How to relieve pain at home

An attack overtakes a person without choosing a place or time. If this happens, first aid for renal colic is necessary.

In order not to cause harm to the patient and not to provoke strengthening pain, you need to follow the emergency care algorithm for renal colic.

Call an ambulance immediately.
Try to calm the patient down and find out the symptoms of his condition.
Measure body temperature.
Apply a heating pad filled to your lower back hot water(pre-wrap with cloth).
Place the patient in a warm bath.

It is allowed to administer antispasmodics only if you know how to do it intramuscular injections(No-shpa, Baralgin). If it is not possible to administer the drug intramuscularly, the listed medications can be used in tablet form.

Heat exposure can cause uterine bleeding and even a miscarriage, so pregnant women in the event of a kidney attack are better off using a heating pad and a bath. You are allowed to take a No-shpa tablet and wait for the doctor to arrive.

Attention! If the patient cannot urinate, under no circumstances should he be given diuretics. They will only increase the speed of stone movement and worsen the patient’s condition.

Alternative Treatments

Medicinal herbs can also help with renal colic. For achievement positive effect The following plants can be used:

celandine;
flax-seed;
carrot seeds;
rose hip.

Celandine: 2 tbsp. spoons of crushed raw materials are poured into a glass of boiling water. After cooling, the decoction is decanted and taken twice a day before meals.

Flaxseed: 1 teaspoon of seeds should be boiled in 1 glass of water, take the product half a glass a day every 2 hours. The decoction can be diluted with water. Take the product for two days.

Carrot seeds: 1 tbsp. a spoon is diluted with a glass of boiling water. The broth is infused, wrapped in cloth, for about 12 hours, after which it is decanted. Take 1/2 cup of warm broth before meals for 2 days.

Rose hips: chopped roots in the amount of 2 tablespoons are boiled in two glasses of water for about 15 minutes. The resulting liquid is wrapped in a cloth and infused until completely cooled, then decanted. Apply the resulting remedy up to four times a day, drinking 1/2 cup at a time. The course lasts seven days.

Important! Self-medication can be dangerous to health.

Accept folk remedies should be used with caution, being confident that the components of the drug are well tolerated.

Specialized medical care in a hospital

A urologist or surgeon can diagnose renal colic, and they can prescribe the optimal treatment. Since attacks often begin suddenly, emergency care is provided by emergency doctors. After examining the patient, doctors decide whether a referral to a urological or therapeutic department is needed.

Immediate hospitalization is necessary in the following cases:

medical care at home does not give the expected results (severe pain persists);
temperature above 39 degrees;
the patient has only one kidney;
pregnancy of any stage or suspicion of it.

After hospitalization of the patient in a hospital, a set of measures is carried out to confirm the diagnosis:

Ultrasound (will help you see the stone);
radiography;
laboratory and clinical research.

When the diagnosis is confirmed, the patient is prescribed hospital treatment. At this stage, the following therapy methods are used:

further use of antispasmodics;
prescribing stronger painkillers;
control is carried out blood pressure and cardiac activity;
use of antibiotics (in case of inflammatory processes);
prescription of a course of vitamins.

The patient must understand that relieving pain and even removing stones does not guarantee recovery. After a certain period of time, a new calculus may form. To prevent new attacks, the patient must follow all the doctor’s instructions: a strict diet is important, right choice physical activity and taking necessary medications.

Limitations and possible contraindications

It is necessary to provide first aid in case of attacks of renal colic, taking into account the following characteristics of the patient:

the reasons that caused the attack;
the age group the patient belongs to;
the presence or absence of concomitant diseases.

If the patient is taking any medications, antispasmodics should be avoided - such drugs do not always combine well with other medications. The age of the patient must also be taken into account. It is not recommended to put elderly people in a warm bath - this is a big burden on the body. Also, a bath is prohibited for people who have had a heart attack or stroke. It is enough to limit yourself to a heating pad or mustard plasters.

An attack of renal colic is not only painful, but also extremely dangerous. Fortunately, you can overcome an attack at home.

The main thing in this situation is not to get confused and know a clear algorithm for providing first aid. It must be remembered that temporary elimination of colic symptoms does not exclude a mandatory trip to a specialist in the future.

Immediate help in the above situations is to call an ambulance - doctors will take the necessary measures to eliminate the attack.

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Symptoms, diagnosis and factors provoking the disease

Renal colic is an attack of severe pain that is associated with a violation of the outflow of urine from the renal pelvis, but can also occur for other reasons. The attack may continue long time and occur both during physical activity and during periods of rest.

The pain spreads to the abdomen, thigh, shoulder, perineum, and genitals. Dizziness, high blood pressure, nausea and vomiting may occur.

If there is an inflammatory process, the temperature may rise. But such symptoms do not always occur; sometimes they can be subtle.

It is necessary to differentiate between spasm associated with impaired renal function and acute appendicitis, when symptoms of irritated peritoneum are present. Diagnosing the cause of an attack most often does not present any particular difficulties, because in patients the urine changes, there is frequent urination and the hypochondrium hurts during palpation.

Factors that can provoke an attack of renal colic:

diet violation;
excess or lack of fluid;
drinking alcohol;
driving on a bad road;
physical or mental stress;
infections.

First aid in case of an attack

The key to favorable and successful treatment is correctly provided first aid and urgent hospitalization. Therapeutic measures are acceptable if the diagnosis was established earlier and you do not doubt its correctness.

To provide first aid for renal colic, you need to have an idea of methods for stopping an attack. Urgently relieving acute pain is the main task of first aid, which can be solved with the help of thermal procedures and the use of antispasmodic and analgesic drugs.

First aid algorithm:

call a doctor;
provide peace;
determine the side and place where the pain is intense;
control temperature;
collect urine for visual examination;
put a heating pad on the lumbar area or fill the bath with water;
give injections of one of the listed antispasmodic and analgesic drugs: noshpa, baralgin, ketan, cystenal, papaverine.

If the procedures do not bring the desired effect, you can use medications. The best drug for pain relief - baralgin. You should not use diuretics, because their use can provoke the movement of stones in the ureter or other undesirable effects.

The attack should stop within 2-3 hours. If there is no positive effect, emergency hospitalization to the urology department is required.

If an attack of renal colic is complicated by acute pyelonephritis and there is a high temperature, then thermal procedures cannot be performed; you must urgently call a doctor.

In most cases, increased heating of the sore spot either reduces the pain or removes it completely.

Correct and timely assistance will restore the functions of the organ and prevent serious complications.

Then you need to be examined by a doctor, who will prescribe a more detailed examination and further treatment depending on the severity of the disease.

Taking antibiotics, installing a stent for urine outflow, novocaine blockade, surgical intervention– There are many treatment options.

Restrictions and contraindications when providing first aid

Renal colic causes severe pain that must be urgently eliminated. It is not difficult to provide it if you know the list of necessary actions.

Urgent Care for renal colic should be provided taking into account:

age of the patient;
presence of concomitant diseases;
reasons for the attack.

An elderly person with a list of diseases should be given assistance with great care, because a hot bath is a strain on the body. If he has suffered a stroke or heart attack, then he should absolutely not take a bath. You need to put mustard plasters, a heating pad, and warm sand on the sore spot.

You cannot give painkiller injections without knowing how they will interact with other medications that the patient was taking before the attack.

First aid in such cases should consist of calling a specialist who will take immediate measures to eliminate the discomfort. He clearly knows the algorithm for providing emergency care, which consists of establishing a preliminary diagnosis and providing assistance according to the appropriate indications.

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What causes renal colic?

The main factors in the mechanism of disorders that cause renal colic are all diseases of the urinary system that contribute to obstruction (impairment of the lumen) of the outflow tract and the growth of salt deposition. It can be:

chronic inflammation (pyelonephritis, cystitis, kidney tuberculosis);
previous injuries and surgeries;
developmental anomalies, nephroptosis;
diseases affecting general metabolism (gout, diabetes).

In 70% of patients, the pathology leads to urolithiasis.

Salt crystals gradually form a rock formation. Size, shape and structure depends on chemical structure. The most traumatic consequences are caused by oxalate stones made from oxalic acid salts. They are distinguished by sharp edges and needle-like ends.

The place of stone formation is most often the renal pelvis and calyces of the kidneys. Crystalline compounds are deposited here and are not excreted in the urine. If the stone is stationary, it may cause no symptoms or may result in dull, intermittent lower back pain.

Signs of renal colic appear when a stone moves into the ureter and is caused by:

muscle spasm urinary tract in response to irritation of nerve receptors located in the submucosal layer;
the addition of a reflex spasm of the kidney vessels, which affects special zones of baroreceptors that respond to pressure drops;
a simultaneous sharp increase in pressure inside the pelvis and cups;
overstretching of the fibrous capsule with accumulation of urine, the occurrence of edema and an increase in the size of the kidney.

We figured out what renal colic is from the point of view of pathogenetic disorders of the urinary tract. Now let's look at the leading symptoms and diagnostic problems.

Clinical manifestations of pain syndrome

The clinic can be divided into:

period of pain;
post-pain symptoms.

Most often, an attack of renal colic is the first manifestation of urolithiasis and forces the patient to resort to emergency care at any time of the day or night. Typically, patients associate the manifestation of the disease with previous long walking, shaking in transport, physical activity, and alcohol intake.

The classic signs are:

cramping pain in the lower back on one side that appeared suddenly;
irradiation (spread) goes to the groin, along the inner surface of the thigh.

The advancement of the stone along the ureter causes a change in irradiation. Men complain of pain in the testicles and penis. Symptoms of renal colic in women are accompanied by pain in the labia.

Irritation of the solar plexus contributes to the occurrence of:

nausea and vomiting at the height of pain;
intestinal paresis with stool retention;
bloating;
identifying unilateral tension in the abdominal and lumbar muscles.

The pain is accompanied by:

expressed anxiety of the patient, attempts to take a comfortable body position;
feeling of thirst;
paleness skin;
reduction in urine output up to complete cessation (oliguria, anuria);
chills with fever;
decreased heart rate;
increased blood pressure;
false urges and pain when urinating.

Very intense pain and a low sensitivity threshold of the patient contribute to the occurrence of a state of shock with:

drop in blood pressure;
secretion of sticky cold sweat.

Characteristics of post-pain symptoms

Help for renal colic relieves or reduces pain, but in the clinic signs of the post-pain period remain.

Hematuria

Discharge of blood in the urine (hematuria) - occurs in 90% of cases. Called:

damage to the mucous membrane of the renal pelvis, calyces, ureter by an advancing stone;
rupture of small arterioles of the renal parenchyma due to a sharp increase in intrapelvic pressure from accumulated urine;
a similar rupture is possible after the stone passes with rapid normalization of pressure.

Hematuria serves as a differential diagnostic sign with pain due to tumors. It occurs only in the post-pain period, and in patients with a tumor and in the pre-pain period.

Signs of hematuria are found after tapping the lower back (definition of Pasternatsky's symptom).

Hematuria will not be detected if you take a urine test during an attack with a persistent block of one ureter. Normal urine will flow through the other (undamaged) ureter.

Urinary disorders

If the stone has been in the lower parts of the ureters adjacent to the bladder, then the following are observed:

nocturia (increased urine output at night);
pollakiuria (frequent urination);
dysuric disorders (cramps, pain, false urges).

Signs of secondary cystitis occur with the rapid addition of infection. At the same time, many leukocytes and bacteria are found in the urine (leukocyturia, bacteriuria). The formation of calculous pyelonephritis may begin.

Stone exit

The most reliable sign and outcome of renal colic is the passage of stones in the urine. In 1/5 patients the process is painless.

Usually this sign is observed soon after a painful attack. The washing out of stone is influenced by:

shape (oxalates dig with sharp edges deep into the wall);
condition of the urinary tract (possible congenital narrowings, concomitant inflammation).

What causes a colic attack?

Factors that provoke symptoms of renal colic include:

violation of diet (overeating meat dishes, fried and spicy foods);
too much or, conversely, insufficient fluid intake;
alcohol, significant amounts of beer;
shaking when driving on a bad road;
overexertion of physical strength;
infectious diseases.

These reasons can disrupt the compensatory mechanisms of the kidneys, disrupt metabolism, and accelerate damage to the urinary tract in the latent course of urolithiasis.

Features of renal colic in women and children

Renal colic in women can be caused by pregnancy and gynecological diseases:

pathological conditions of the uterus (disturbed location, inflection);
inflammatory diseases of the appendages (adnexitis);
damage during tubal pregnancy;
torsion of the “leg” with cystic changes in the ovary;
hemorrhage and rupture (apoplexy) of the ovary;
spontaneous miscarriage.

Therefore, any woman taken to the hospital by ambulance with a diagnosis of renal colic should be examined by a gynecologist.

Some women with advanced pregnancy perceive pain as the beginning of contractions and go into labor. house. If it is determined that there are no signs of labor, the patient is transferred to the pathology department, where she is completely examined and possible treatment before giving birth.

In children, stone formation often depends on the presence of inflammatory kidney diseases. Stones consist of mucus, fibrin, desquamated epithelium, leukocytes, and bacteria. In the occurrence of renal colic, pediatricians attach importance to family predisposition. This is due to the genetically determined course of metabolism.

Risk factors in early childhood include:

increased fluid loss (with frequent diarrhea, vomiting, development of malabsorption syndrome);
treatment with drugs toxic effect on the kidneys.

In junior childhood the localization of pain does not correspond to classical signs. It occurs in the navel area, accompanied by bloating and vomiting. The child is excited, scared, and crying. A slight increase in temperature is possible.

How to make a correct diagnosis?

When talking with a patient or parents of a sick child, you need to find out everything about the cause and nature of the disease.

Therefore, you will have to remember and answer the questions:

how the pain began suddenly or gradually;
where they give it and how much it has changed over time;
whether there were chills, nausea or vomiting;
are there any difficulties or pain when urinating;
is this the first attack or similar manifestations have already occurred before;
whether the patient and his relatives were diagnosed with urolithiasis.

During the examination, the doctor pays attention to:

type of patient;
painful palpation of the kidney on the affected side;
positive Pasternatsky symptom;
bloating and muscle tension abdominal wall and in the lower back.

Violations of the filtration function of the kidneys with the accumulation of nitrogenous substances, suspected when the content of electrolytes changes. Anemia is detected during the formation renal failure. A urine test reveals a significant amount of red blood cells, mucus, salt in the form of cylinders, moderate leukocyturia, and epithelial cells.

Renal colic must be distinguished from other pathologies with similar symptoms. These include all conditions called by one term “acute abdomen”:

acute appendicitis;
dyskinesia biliary tract, cholecystitis and pancreatitis with hepatic colic;
perforation of stomach and duodenal ulcers;
attack of intestinal obstruction;
such vascular diseases, such as aortic dissection, thromboembolism of the mesenteric arteries.

In women it is necessary to exclude:

adnexitis (inflammation of the appendages);
ectopic pregnancy;
possible torsion of the pedicle of an ovarian cyst.

Lower back pain radiating to the groin is accompanied by:

intercostal neuralgia;
intervertebral disc herniation with radicular pain syndrome;
herpes zoster caused by herpes infection.

For each disease, it is necessary to take into account the patient’s history, age, characteristics of pain and accompanying symptoms. Correct diagnosis determines the choice of measures necessary for targeted therapy in order to make them most effective.

The doctor can obtain maximum information by:

ultrasound examination of the kidneys and bladder, if it is completely full;
X-ray examination (excretory urography);
chromocystoscopy - an endoscopic method for detecting ureteral obstruction with the introduction of indigo carmine.

What first aid should be provided during an attack?

First aid for renal colic can be provided before calling an ambulance at home. It is only important to be sure of urolithiasis as the cause of pain. This is possible if the patient has previously suffered similar attacks and was diagnosed during examination.

In such cases, it is permissible to use such methods of first aid as:

applying a hot heating pad to the lower back;
placing the patient in a bath with warm water;
administration of an intramuscular antispasmodic drug (No-shpa, Platyfillin, Baralgin);
oral administration of Cystenal.

It must be remembered that thermal procedures are strictly contraindicated in inflammatory diseases, tumors, damage to the pelvic vessels, during pregnancy. For the expectant mother You can be allowed to take a No-shpa tablet. Warming promotes termination of pregnancy and uterine bleeding.

The algorithm of actions when providing assistance to a patient consists of pre-medical measures and the use of special medications medical workers. In case of a painful attack you must:

call an ambulance;
reassure the patient, find out the symptoms and previous course of the disease;
put a thermometer to measure temperature;
determine together with the patient the maximum localization of pain and irradiation;
pour into a heating pad hot water, wrap in a towel and apply to the lower back on the affected side;
give Cystenal for oral administration, if skills allow, give an injection of one of the antispasmodics.

If the ambulance is delayed for a long time, it is permissible to place the patient in a hot bath of water. Timely emergency care for renal colic helps preserve the kidneys and improves the outcome of further treatment.

When is a patient admitted to the hospital?

The attack is usually stopped at home by measures provided by loved ones and the ambulance. In the future, the person should consult a doctor at the clinic for full examination and treatment prescriptions.

Hospitalization is considered mandatory if:

unsuccessful actions of the ambulance staff and unresolved pain in the patient;
solitary kidney or severe attack with pain in the transplanted donor organ;
high body temperature, suspected infection;
pregnancy.

In the hospital:

continue to use antispasmodic drugs;
use stronger painkillers;
if pain persists, perinephric novocaine blockade is performed;
prescribe symptomatic anti-vomiting medications;
control blood pressure and cardiac status;
if signs of inflammation appear, a course of antibiotic therapy is administered;
vitamins are prescribed.

To determine further tactics for patient management, the results of the examination are taken into account and the issue of planned surgical treatment for the purpose of installing a stent and removing the stone, about the indications for the use of ultrasound therapy.

Patients should understand that passing a stone after an attack does not mean complete recovery. Changes in salt metabolism in the body remain. This means that after some time another stone will form and the attack will repeat. Therefore, you should be attentive to the recommendations on diet, physical activity, intake medicines.

Renal colic is quite common and at the same time dangerous condition, requiring immediate first aid to the patient, otherwise an attack can lead to serious and irreversible consequences.

Colic is not an independent disease. This disease is a clinical syndrome that occurs against the background of certain pathologies of the kidneys and other organs of the urinary system. Renal colic is characterized by the sudden onset of severe paroxysmal burning, stabbing or cutting pain. Emergency care for renal colic helps to alleviate the patient’s condition, as well as prevent various complications.

According to statistics, the prevalence of this condition among the population is 10%. Pain syndrome can occur in any person, regardless of gender and age. The first and main symptom of the disease is intense pain in the lower parts of the spinal column. The pain can radiate to the abdomen, perineum, and shoulder. Moreover, the pain is often paroxysmal in nature. Characteristic sign renal colic - the inability to relieve pain by changing the position of the body.

An attack can occur both after physical activity and at rest. Renal colic is usually caused by:

blockage of the ureter;
the formation of a blood clot that interferes with the passage of urine;
renal ischemia;
accumulation of purulent or mucous contents;
spasm of the pelvis;
genetic predisposition;
muscle spasm of the ureter;
deposition of uric acid salts;
blockage of the urinary tract;
physical overstrain;
alcohol abuse;
violation of diet;
kidney tuberculosis;
benign or malignant neoplasm;
acute pyelonephitis;
prolapse of the kidneys;
dystopia;

In addition, the disease can develop due to post-traumatic hematomas. One of the most common causes of an attack of colic is the presence of stones in the ureter or kidneys. With kidney stones, colic occurs in every second person, and with blockage of the ureter - in almost everyone.

The occurrence of colic-type pain syndrome can be triggered by inflammatory diseases (urethritis, prostatitis). Rarely, but still possible, the cause of the disease lies in the presence of vascular pathology (thrombosis or embolism).

In some cases, the appearance of an attack is caused by congenital anomalies organs of the urinary system (spongy kidney, achalasia). Among representatives of the weaker half of society, colic can occur due to gynecological ailments. Uterine fibroids and salpingoophoritis provoke the appearance of adhesions, which is a trigger for increased pressure in the kidneys.

Main signs of renal colic

The attack usually occurs suddenly. In this situation, no trigger mechanism can be traced, for example, a stressful situation or intense exercise stress. The main symptom of colic is pain. The pain in this condition is intense, acute, paroxysmal. It occurs for no apparent reason.

In addition to pain, colic is characterized by nausea, vomiting, the appearance of blood in the urine, pain in the urethra, xerostomia, decreased diuresis, anuria, increased blood pressure, and increased heart rate.

Due to severe pain, a state of shock may develop, accompanied by paleness of the dermis, cold sweat, bradycardia, tremors of the limbs, malaise, pre-syncope and fainting states.

The duration of the attack may vary. Colic can last from several hours to a day. In this case, painful sensations may either intensify or weaken.

First aid

Timely and correct assistance and urgent hospitalization are the key to favorable and successful therapy. The main goal of first aid for colic is to eliminate pain.

Quite often, emergency care for illness is provided at home. The attack may appear suddenly at home, at work or on the street. Every person should know the algorithm for providing first aid during an attack.

Help with colic includes the following measures:

calling an ambulance;
providing the victim with peace;
elimination of pain;
application of heat;
measuring body temperature;
assessment of the patient’s general condition;
determining the location of pain.

All actions must be balanced and as correct as possible. Don’t worry, your excitement will be passed on to the patient, and he’s already feeling bad right now. Get yourself together and start acting in order.

Provide the patient with as much rest as possible.
If possible, collect urine. Next, it needs to be handed over to a specialist who will check it for the presence of stones.

Doctors advise starting therapy with the use of any thermal procedures. This could be a warm bath or a heating pad on your stomach or lower back.

The use of heat is contraindicated if a person has had a heart attack or stroke.

If the patient has a fever and other signs of intoxication are present, warming is not used. If thermal procedures do not bring relief and the person still complains of severe pain, it is necessary to give him an analgesic or antispasmodic. You can eliminate the pain with No-shpa, Papaverine, Pentalgin, Baralgin, Platyfillin, Diclofenac or Ibuprofen.

If all of the above actions turned out to be ineffective, the patient must be administered intramuscularly with a narcotic painkiller: Promedol or Morphine.

At complete absence the expected effect after all these measures, the patient must be hospitalized in the urological or surgical department. There they will perform urgent catheterization of the ureter or puncture nephrostomy or other surgical treatment.

An acute attack of pain in the lumbar region, like a cramp, is a sign of kidney pathology; it knocks any person out of the usual rhythm of life. Emergency care for renal colic plays a major role in the proper relief of a painful attack and should be provided immediately. Correctly provided care will improve the healing process and help doctors in a short time regulate the general condition of a person.

Urgent Care

Pre-medical first aid for renal colic should be competent and timely. It is necessary to follow the correct algorithm for carrying out special procedures. It is important to understand that only if you are clearly convinced of the diagnosis can you take independent steps and use medications, otherwise you need to urgently seek help from doctors.

What to do with renal colic in the first minutes?

Providing emergency first aid at home is possible with a clear knowledge of all methods for localizing colic. At the first stage, pain can be relieved by using thermal methods and special medications. The sequence of procedures is as follows:

call an ambulance;
create a calm environment;
establish the location of pain;
monitor possible temperature changes;
collect urine.

Removing spasms and restoring normal urine flow is the result for which all procedures are carried out. pre-medical care help. The kidneys are very sensitive to heat, so the patient must be provided with warm objects: wrap him in a blanket, put a heating pad on him. As a rule, warming the area where the pain occurs leads to its reduction or complete cessation.

How to relieve pain with drugs?

After thermal procedures, the patient can be administered painkillers or antispasmodics. Medicines can be in the form of tablets and injections. Antispasmodics for renal colic relieve muscle tone of the ureter, improving the patency of the ducts. Most often, myotropic drugs are used for renal colic (No-Shpa, Papaverine, etc.). If you're worried sharp pain pain relief is best done with combination drugs(“Spazmonet”, “Baralgin”, “Avisan” and others). Let's look at frequently used ones in more detail.

"No-Shpa" ("Drotaverine")

The most popular medicine that is always at hand. It can be taken not only as a medicine for renal colic, but also to relieve any pain. By reducing the supply of calcium to muscle cells, the drug reduces muscle tone. To relieve pain from renal colic, you can take 4 tablets at once, but in case of emergency, to relieve an attack of renal colic, you must administer the drug intramuscularly.

"Baralgin" (BARALGIN)

A potent drug (stronger than No-Shpy). Tablets (0.5-2 pieces several times a day) act much more slowly, because they must go through the entire digestion path. The solution (2 ml) goes directly into the blood, so injections for renal colic are more effective. The drug contains a fairly large dosage of components, and in order to avoid a decrease in blood pressure, it must be administered very slowly. At intramuscular injection(5ml-1 ampoule) solution, entering the blood, begins to act within a few minutes.

It is forbidden to relieve spasms using Analgin. It can distort the manifestation of symptoms, thereby complicating the diagnosis of the disease.

"Ketorol" (KETOROL)

You can relieve renal colic at home with Ketorol only if you are firmly convinced of the correct diagnosis. The drug helps relieve pain, but at the same time it will cover all the symptoms. For treatment at home, Ketorol is administered intramuscularly. The injection is given slowly (over half a minute), the result occurs after 30 minutes.

"Platifillin"

Refers to drugs that act on cells (cholinergic receptors) in which neuromuscular transmission occurs. It is well tolerated, but not very effective (it resembles Papaverine in action). The attack is stopped by subcutaneous injection of a 0.2% solution (1-2 ml).

Contraindications and restrictions

When providing emergency care, it is important to remember that any method that eliminates kidney pain has its contraindications. Any intervention for renal colic at home should be supported by knowledge:

It is necessary to ask the patient about any contraindications or allergic reactions for medications.
It is important to understand that treating colic medicines You can't do it without a doctor's supervision. They are used as an aid to relieve an attack of kidney stones. Their long-term use can lead to deterioration of health. Pain is a symptom of a disease that requires a full examination and treatment.
The use of thermal procedures is prohibited during inflammatory processes.
If a painful attack occurs in an elderly person, it is better to use a heating pad rather than a bath with warm water. This approach will prevent the development of a heart attack.

After providing first aid, you must call a doctor or take the patient to the clinic.

When is hospitalization required for renal colic?

The decision to hospitalize is made based on the patient’s symptoms and well-being.

Suspicion of renal colic requires prompt action, and ambulance will deliver the patient to the clinic quickly and under professional supervision. Hospitalization is indicated in any case, because kidney stones, having changed their position, can clog the ducts, and the attack will recur. Even with good dynamics, the patient is observed in the hospital for 3 days. There are situations in which hospitalization is mandatory:

The pain does not go away after using medications.
Feeling worse:
- vomit;
- urinary disturbance;
- complete absence of the urge to urinate.
Pain on both sides.
Accession inflammatory process, which is confirmed by the increased temperature.
At physiological feature(one kidney per person).

If relief of renal colic at home has been successful and the person refuses hospitalization, then it is recommended that he dietary food, warmth in the back area and control when urinating. It is important to collect urine in a clean container to monitor for sediment or stone passage. But it is advisable to conduct an examination with a urologist to exclude the development of complications.

The doctor’s task in case of renal colic is to relieve the pain attack as quickly as possible.

If painkillers for renal colic do not relieve acute painful sensations, and the duration of renal colic reaches several hours and no improvement is expected, the main task of doctors is to relieve the attack in a short time. Interviewing the patient will provide information about what pre-medical care was taken, which will help in making decisions about further treatment of the patient.

As a rule, stopping an attack always begins with analgesics or antispasmodics. In case of a prolonged attack, droppers from complex medicinal mixtures or novocaine blockade can help. While they are dripping, the nurse performs an independent intervention (monitors the patient’s condition). At this time, a dropper from “Baralgin” No-shpa, “Platifillin”, glucose is indicated, also intramuscular injections of “Analgin”, “Pipolfen”, “Platifillin” are prescribed additionally “Promedol”, “Diphenhydramine”, “Papaverine”, “No” -shpa."

Further therapy consists of finding out the causes of colic and the degree of obstruction of the urinary system. Dependent interventions are required (collection of material for lab tests). If renal colic occurs against the background of an inflammatory process, the doctor will definitely prescribe an antibiotic, most likely they will prescribe antibiotics wide range actions. It is not always possible to quickly eliminate the infection in the case of urolithiasis, so drugs are prescribed before the stone is removed from the body. If edema is present, diuretics are prescribed.

If a person has renal colic, emergency care (algorithm) can alleviate the patient’s condition and prevent various complications. Colic is not an independent disease. This clinical syndrome, which can occur against the background of certain diseases of the kidneys and other organs of the urinary system. What are the causes, signs and treatment of renal colic?

Characteristics of the disease

Colic is a severe, paroxysmal pain. The prevalence of this condition among the population reaches 10%. Pain syndrome can occur in people of any age and gender. The development of this symptom may be based on the following processes:

blockage of the ureter;
the formation of a blood clot that interferes with the passage of urine;
deposition of uric acid salts;
blockage of the urinary tract with necrotic masses;
muscle spasm of the ureter;
spasm of the pelvis;
accumulation of mucus or pus;
renal ischemia.

Depending on the level of the lesion, pain may be felt in the lower back, lower abdomen, or along the ureters. Most often, colic is felt on one side. Pain is the result of stretching of the renal pelvis and kidney capsule. This type of pain is one of the most intense in medical practice. This condition requires urgent attention.

Etiological factors

Colic occurs with the following diseases and pathological conditions:

urolithiasis;
kidney tuberculosis;
benign and malignant tumors;
hydronephrosis;
narrowing of the ureter;
acute pyelonephritis;
torsion of the ureter;
prolapse of the kidneys;
dystopia;
prostate cancer;
benign prostatic hyperplasia.

The cause may be post-traumatic hematomas. Most common reason- presence of stones in the kidneys or ureter. In the presence of a kidney stone, colic develops in every second patient. When the ureter is blocked - in almost all patients. Severe colic-type pain syndrome can occur with inflammatory diseases (urethritis, prostatitis). Less commonly, the cause lies in vascular pathology (vein thrombosis in the kidney area, embolism). In some patients, colic is caused by congenital organ abnormalities (achalasia, spongy kidney).

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In women, colic can develop against the background of gynecological diseases (salpingoophoritis, uterine fibroids). These diseases often lead to adhesive disease, which is a trigger for increased pressure in the kidneys. Predisposing factors for the development of renal colic include family history (cases of colic in close relatives), previous history of urolithiasis, poor nutrition (excess in the diet of meat products and canned food), insufficient fluid intake, heavy physical labor, hypothermia, the presence of lesions chronic infection, presence of systemic diseases connective tissue and urethritis.

Signs of the disease

Colic appears suddenly against the background of complete well-being. In this situation, no trigger factor (physical activity, stress) can be traced. Pain syndrome can overtake a person at work, school or at home. Main sign colic - pain. It has the following features:

high intensity;
acute;
cramping;
appears unexpectedly;
does not depend on human movements;
localized in the lower back, on the side of the kidney or in the groin area;
gives to the genitals, groin area, anus;
often combined with nausea and vomiting;
often manifested by a change in the nature of urine (blood appears in it).

Nausea and vomiting are observed with colic, which is caused by a violation of the outflow of urine in the kidneys or ureters. Vomiting does not improve the condition of a sick person. With obstruction of the lower ureter, dysuric phenomena (frequent and painful urination) may occur. In some cases, ischuria occurs. Fever, chills and general malaise indicate the presence of an inflammatory process. Stagnation of urine is a favorable factor for the activation of microorganisms, which leads to inflammation.

The duration of colic varies. It can last from 3 hours to a day or more. The pain may wax and wane. All this significantly worsens the patient's condition. He can't find a place for himself. There is pronounced excitability. In severe cases, colic can cause loss of consciousness. Against the background of colic, the patient may be bothered by the following complaints:

pain in the urethra;
dry mouth;
decreased diuresis;
anuria;
increased blood pressure;
increase in heart rate.

Severe pain can lead to shock. In this case, pale skin, cold sweat, bradycardia, and a drop in blood pressure are observed.

Patient examination plan

Cramping pain can be observed not only in diseases of the organs genitourinary system. To establish the underlying disease, a series of studies should be carried out. Diagnostics includes taking an anamnesis, palpation of the abdomen, determining the symptom of a concussion in the lumbar region, ultrasound of the kidneys and bladder, blood and urine tests, and urography. Diagnosis begins with interviewing the patient. During it, the characteristics of the pain syndrome and accompanying complaints are determined. It is important to indicate to the patient that there is a problem with urination and a change in the color of the urine.

With kidney damage, a positive Pasternatsky sign is very often detected. The most informative is general analysis urine. Availability large quantity leukocytes indicates the presence of pyelonephritis. Leukocytosis in combination with hematuria may indicate urolithiasis or glomerulonephritis. With urolithiasis, fresh red blood cells are found. To exclude glomerulonephritis, an ultrasound scan is required. Differential diagnosis of renal colic is carried out with pain in other acute diseases (appendicitis, cholecystitis, pancreatitis, peptic ulcer).

First aid

For renal colic, first aid is great importance, since from the timeliness of provision medical care and hospitalization of a sick person depends on his further condition. The main goal of emergency care for colic is to eliminate pain. There are often cases when first aid for renal colic is provided at home. Colic can occur unexpectedly at home, on the street or at work. Every person should know what to do in this situation. Emergency care for renal colic includes the following measures:

calling a doctor or ambulance;
ensuring peace for the victim;
elimination of pain syndrome;
warming the patient (using a heating pad);
determination of body temperature and general condition of the victim;
determination of pain localization.

If possible, urine should be collected. First, it is necessary to eliminate the pain using thermal procedures. To do this, you can place a heating pad on the area where the pain is felt. An alternative method is to sit the victim in a bath of hot water. Heat will reduce pain and alleviate the patient's condition. The use of heat is justified only in the absence of an acute inflammatory process. Hot baths are contraindicated for people who have had a stroke or heart attack. At high body temperature and other signs of intoxication, heating is not used. If thermal procedures do not help, pain relievers (antispasmodics or analgesics) are used.

If skills allow, it is better to administer the medicine intramuscularly. The following medications can be used to relieve colic:

No-shpa;
Papaverine;
Drotaverine;
Baralgin;
Pentalgin;
Platyfillin;
Diclofenac;
Ibuprofen.

If colic does not disappear, medical workers may carry out novocaine blockades. In a hospital setting, catheterization or stenting can be performed. Diuretics are not used to relieve renal colic, since stimulating urination can lead to the advancement of the stone, which can cause increased pain. Emergency care for renal colic should be carried out as early as possible. To avoid complications and painful shock, this must be done within 2-3 hours from the onset of colic. After relief of colic, a thorough examination is carried out. Further treatment is aimed at eliminating the underlying cause of colic.

Therapeutic measures

Once the underlying disease is established, treatment is carried out. For nephrolithiasis (kidney stones), treatment can be conservative or surgical. Small stones less than 3 mm in size can be removed independently. In this case, the patient is prescribed a strict diet, depending on the type of stones, and drinking plenty of fluids. Medicines are used to dissolve the stones. To eliminate the inflammatory process, antibiotics and nitrofurans are used. For frequent colic due to kidney stones, lithotripsy and lithoextraction can be performed. If after this the stones do not disappear, radical surgery. If renal tuberculosis is detected, long-term therapy with anti-tuberculosis drugs is carried out. Colic in the background acute pyelonephritis requires antibiotics. Thus, if a person has developed renal colic, the symptoms will be very pronounced. First aid consists of eliminating pain and calling an ambulance.

Renal colic is a manifestation of a concomitant symptom of many diseases of the kidneys or genitourinary system. Characteristic feature colic is characterized by an abrupt onset and severe pain that continues throughout the attack.

This condition is dangerous due to its severe, often irreversible consequences, so it is important to know the algorithm for providing emergency care for renal colic.

Causes and symptoms

Before you begin to relieve renal colic, you need to understand the cause of its occurrence and the characteristics of its manifestation.

An attack characterized by sudden pain occurs due to the following: pathological changes in organism:

The presence of tumor processes in the kidney tissues;
Movement of stones in the urinary tract system;
Kidney damage due to mechanical stress;
Renal tuberculosis;
Excessive physical activity;
Alcohol abuse;
Narrow lumen in the ureter;
Formations of a benign or malignant nature in the uterine area, thyroid gland or in the digestive tract;
Kidney prolapse.

With these diseases, the kidneys often hurt, and a sharp attack of pain can strike at any moment.

However, when providing assistance for renal colic, it is important to know not only about the presence of pathological changes, but also about the reasons that caused them:

Stones that are in the kidneys;
Blood lumps formed in the kidney space;
Plugs of pus in the urinary tract;
Bend or swelling in the ureter.

If there is no information about clinical picture diseases, emergency care for renal colic is provided based on the symptoms of the attack.

Sharp, severe pain during spasm, which can cause fainting or painful shock.
Blood clots appear in the urine.
Without first aid, the pain felt in the abdomen, groin and sides intensifies.
When the bladder is emptied, little or no urine comes out.
Inability to defecate.

If kidney function is impaired, the symptoms intensify and manifest themselves in the following disorders:

Manifestations of pain when urinating;

Dizziness;
Rapid increase in body temperature and blood pressure;
Nausea;
Vomit.

Note!

Important symptoms of colic are the inability to eliminate pain when changing body position and its paroxysmal nature.

The duration of the attack depends on the individual characteristics of the body, as well as the reasons that caused renal colic. Thus, cases of colic have been recorded that lasted from 2 hours to 3 days.

These symptoms require immediate medical intervention, and to relieve pain, use first aid.

First aid

Conditions accompanied by renal colic require careful diagnosis and complex treatment medications.

First aid in case of renal colic, it is needed in order to relieve pain, preventing loss of consciousness and the manifestation of painful shock in the patient. To achieve these goals, the following algorithm of actions was developed:

Call medical personnel immediately;
Provide the patient with an upright position so that the lower back is slightly elevated;
For kidney pain, you can use heat in the form of a heating pad applied to the lower back;
At the first manifestations of spasm, you can offer the patient to take a bath filled with warm water;
If, after the attack has passed, your kidneys hurt badly, you can take medications that relieve the spasm by relaxing the muscles;
Any urge to urinate cannot be ignored, therefore, if help is provided at home, it is necessary to ensure that the patient is able to satisfy his needs even while lying down.

Note!

When providing emergency care, it is prohibited to use analgesics, as the symptoms will be distorted and it will be difficult for doctors to make a diagnosis.

We must remember that it is imperative to seek help from doctors, even if emergency help eliminated spasm accompanied by colic. After all, to prevent the attack from happening again, you need to eliminate the root cause that caused it, and this can only be done with medical help.

Precautionary measures

When providing first aid for renal colic, you need to remember about contraindications for concomitant diseases:

A hot bath should not be used by elderly people or persons with pathological changes in the cardiovascular system;
The use of localized heating is prohibited for patients diagnosed with inflammation of internal organs;
In case of kidney diseases accompanied by colic, diuretics create the opposite effect, increasing the pain syndrome.

When providing assistance with spasms in the kidneys at home, you need to remember that at this stage you can use only those methods that will not cause harm or increase the pain syndrome.

First aid for renal colic is considered effective if the patient no longer feels spasmodic pain, and his condition has improved significantly.

If the symptoms begin to intensify, the patient must be urgently hospitalized.

Patients who exhibit the following symptoms are subject to immediate hospitalization:

Body temperature and blood pressure are very high;
Antispasmodic and painkillers did not bring relief;
An acute development of the infectious process occurs when the urinary system is blocked by a stone.

In these cases, what to do to alleviate the patient’s condition should be decided by the ambulance doctors.

Specifics of medical care

Initial medical care consists of pain relief with medications:

The use of intramuscular and intravenous medications that relieve pain and the cause of its occurrence. The most commonly used drugs are Ketorolac and Diclofenac, which have not only analgesic but also anti-inflammatory properties.

Action to eliminate vomiting involves administering antiemetics, such as Metoclopramide.
As emergency medications, myotropic antispasmodics are used, which are administered simultaneously with analgesics.
In the event that these drugs do not have the desired effect, assistance is provided with the help of narcotic analgesics (Morphine, Tramadol), which are administered in combination with Atropine, which relieves spasms.
If kidney stones are diagnosed, the patient can be helped with medications that have an alkalizing effect on urine: “Sodium Bicarbonate” or “Potassium Citrate”. These drugs help the stones dissolve and leave the body as painlessly as possible.

After the alarming symptoms are eliminated, the patient is hospitalized to diagnose the cause that caused renal colic.

The first test is an ultrasound examination of the kidneys. The doctor then analyzes clinical, laboratory and radiological diagnostics to confirm the diagnosis.

In the moment diagnostic studies The patient continues to receive medical care, which consists of taking diuretics and synthetic vitamin-mineral complexes.

In case of pronounced symptoms and poor relief of pain, surgical intervention is performed in the following cases:

Renal hydronephrosis;
The presence of large stones that blocked the ureter;
Shrinkage of the kidneys.

It should be noted that renal colic is a serious manifestation of pathological changes in the kidneys and nearby organs. Therefore, as soon as the kidney or abdominal area begins to hurt, you need to urgently contact medical institution to make an accurate diagnosis.

Despite the fact that traditional medicine offers several recipes for relieving pain, treatment of renal colic with home remedies is prohibited, and the use of medications is possible only after an accurate diagnosis and medical prescriptions.

A patient who first encountered severe pain in the kidney area, may confuse the pain syndrome of appendicitis, ulcers or pancreatitis with colic. Therefore any medications and infusions from medicinal herbs without specifying the diagnosis, they can cause significant harm to human health.

propomosch.ru

Characteristics of the disease

blockage of the ureter;
the formation of a blood clot that interferes with the passage of urine;
deposition of uric acid salts;
blockage of the urinary tract with necrotic masses;
muscle spasm of the ureter;
spasm of the pelvis;
accumulation of mucus or pus;
renal ischemia.

Etiological factors

Colic occurs with the following diseases and pathological conditions:

urolithiasis;
kidney tuberculosis;
benign and malignant tumors;
hydronephrosis;
narrowing of the ureter;
acute pyelonephritis;
torsion of the ureter;
prolapse of the kidneys;
dystopia;
prostate cancer;
benign prostatic hyperplasia.

The cause may be post-traumatic hematomas. The most common cause is the presence of stones in the kidneys or ureter. In the presence of a kidney stone, colic develops in every second patient. In case of blockage of the ureter - in almost all patients. Severe colic-type pain syndrome can occur with inflammatory diseases (urethritis, prostatitis). Less commonly, the cause lies in vascular pathology (vein thrombosis in the kidney area, embolism). In some patients, colic is caused by congenital organ abnormalities (achalasia, spongy kidney).

In women, colic can develop against the background of gynecological diseases (salpingoophoritis, uterine fibroids). These diseases often lead to adhesive disease, which is a trigger for increased pressure in the kidneys. Predisposing factors for the development of renal colic include family history (cases of colic in close relatives), previous history of urolithiasis, poor nutrition (excess in the diet of meat products and canned food), insufficient fluid intake, heavy physical labor, hypothermia, the presence of foci of chronic infection, the presence of systemic connective tissue diseases and urethritis.

Signs of the disease

Colic appears suddenly against the background of complete well-being. In this situation, no trigger factor (physical activity, stress) can be traced. Pain syndrome can overtake a person at work, school or at home. The main symptom of colic is pain. It has the following features:

high intensity;
acute;
cramping;
appears unexpectedly;
does not depend on human movements;
localized in the lower back, on the side of the kidney or in the groin area;
gives to the genitals, groin area, anus;
often combined with nausea and vomiting;
often manifested by a change in the nature of urine (blood appears in it).

pain in the urethra;
dry mouth;
decreased diuresis;
anuria;
increased blood pressure;
increase in heart rate.

Severe pain can lead to shock. In this case, pale skin, cold sweat, bradycardia, and a drop in blood pressure are observed.

Patient examination plan

Cramping pain can be observed not only with diseases of the genitourinary system. To establish the underlying disease, a series of studies should be carried out. Diagnostics includes taking an anamnesis, palpation of the abdomen, determining the symptom of a concussion in the lumbar region, ultrasound of the kidneys and bladder, blood and urine tests, and urography. Diagnosis begins with interviewing the patient. During it, the characteristics of the pain syndrome and accompanying complaints are determined. It is important to indicate to the patient that there is a problem with urination and a change in the color of the urine.

With kidney damage, a positive Pasternatsky sign is very often detected. The most informative is a general urine test. The presence of a large number of leukocytes indicates the presence of pyelonephritis. Leukocytosis in combination with hematuria may indicate urolithiasis or glomerulonephritis. With urolithiasis, fresh red blood cells are found. To exclude glomerulonephritis, an ultrasound scan is required. Differential diagnosis of renal colic is carried out with pain in other acute diseases (appendicitis, cholecystitis, pancreatitis, peptic ulcer).

First aid

With renal colic, first aid is of great importance, since the timeliness of medical care and hospitalization of the sick person depends on his further condition. The main goal of emergency care for colic is to eliminate pain. There are often cases when first aid for renal colic is provided at home. Colic can occur unexpectedly at home, on the street or at work. Every person should know what to do in this situation. Emergency care for renal colic includes the following measures:

calling a doctor or ambulance;
ensuring peace for the victim;
elimination of pain syndrome;
warming the patient (using a heating pad);
determination of body temperature and general condition of the victim;
determination of pain localization.

If skills allow, it is better to administer the medicine intramuscularly. The following medications can be used to relieve colic:

No-shpa;
Papaverine;
Drotaverine;
Baralgin;
Pentalgin;
Platyfillin;
Diclofenac;
Ibuprofen.

Therapeutic measures

Once the underlying disease is established, treatment is carried out. For nephrolithiasis (kidney stones), treatment can be conservative or surgical. Small stones less than 3 mm in size can be removed independently. In this case, the patient is prescribed a strict diet, depending on the type of stones, and drinking plenty of fluids. Medicines are used to dissolve the stones. To eliminate the inflammatory process, antibiotics and nitrofurans are used. For frequent colic due to kidney stones, lithotripsy and lithoextraction can be performed. If after this the stones do not disappear, a radical operation is performed. If renal tuberculosis is detected, long-term therapy with anti-tuberculosis drugs is carried out. Colic due to acute pyelonephritis requires antibiotics. Thus, if a person has developed renal colic, the symptoms will be very pronounced. First aid consists of eliminating pain and calling an ambulance.

nefrolab.ru

Characteristics of renal colic

What's happening

This condition occurs due to a violation of the outflow of urine due to stretching of the renal pelvis.

When an obstacle appears in the path of urine, the following phenomena occur:

the renal pelvis becomes full, the pressure in it increases,
venous congestion occurs
Renal ischemia develops (swelling of the interstitial tissue, stretching of the renal capsule).

Origins of pathology

Among reasons of this disease are in the lead:

Stone migration.
Blockage of the ureter by caseous masses or a blood clot.
Tuberculosis and tumors of the urinary system.
Inflammatory processes or kinking of the ureter, disrupting its patency.

Colic is often considered a complication of urolithiasis in the stage of blockage of the lumen of the ureter by a stone. The response to blockage is spasm, which causes pain.

How does the disease manifest itself?

Renal colic is characterized by a sudden onset of an attack. First, unbearable pain appears in the lumbar region.

Then it spreads to the hypochondrium and abdomen. The pain moves in the direction from the ureter to the bladder, scrotum (in men), labia (in women), and thighs. Often the pain is strongest in the abdomen or genitals, and less in the kidney area.

In addition to pain, there is a frequent urge to urinate and pain in the urethra. After an attack, an increase in the level of leukocytes and red blood cells in the urine is detected.

In parallel with colic, the following may occur:

irritation of the peritoneum, as well as the solar plexus,
nausea with vomiting,
desire to defecate,
dizziness.

Diagnostic scheme

The first task of diagnostic measures is differentiation with the condition “ acute abdomen", exception:

appendicitis,
pancreatitis,
cholecystitis,
thrombosis of mesenteric vessels (intestinal mesentery),
intestinal obstruction,
radiculitis,
perforated gastric ulcer (duodenum),
adnexitis (inflammation of the appendages),
ectopic pregnancy,
torsion of an ovarian cyst,
intercostal neuralgia,
herpes zoster.

Evidence of renal colic

It is not difficult to distinguish this condition from other diseases. In addition to traditional symptoms with a history, evidence of colic serve:

painful sensations in the spinal-costal angle,
bimanual palpation causes pain in the hypochondrium,
the presence of a positive Pasternatsky symptom (pain from tapping the lumbar region).

Other signals are the localization of pain under the “spoon”, then in the right hypochondrium, and its spread throughout the abdomen. When inhaling, the pain intensifies, it radiates to the right shoulder and shoulder blade. Pain occurs when palpating the gallbladder area.

Importance of emergency care

What to do at the beginning of an attack

Correct actions to provide emergency care after the onset of symptoms of renal colic contribute to successful treatment. They may be sufficient without hospitalization of the patient.

First you need to call an ambulance.

If the attack has not occurred for the first time, and the patient is sure that it is renal colic, then before the doctor arrives, his condition can be alleviated. When providing first emergency aid for renal colic, a certain algorithm of actions should be followed.

It is necessary to provide the patient with complete rest, put a heating pad on the lower back (you can take a hot bath). At the same time, give antispasmodics and painkillers from your home medicine cabinet. These include:

baralgin (1 table),
Avisan (1 year),
papaverine (1 table),
cystenal (15-20 drops).

The help of a physician consists of prescribing thermal procedures with the simultaneous administration antispasmodics, painkillers:

baralgin 5 ml intravenously or intramuscularly,
atropine (1% solution),
subcutaneously pantopon, platiphylline.

If the attack stops and you feel better, hospitalization is not necessary.

If you do not trust medication methods, then you can use the secrets traditional medicine for relieving kidney pain or prevention.

If the colic does not go away within two hours, the patient is hospitalized in the urology department.

When urgent hospitalization is necessary

Indications for hospitalization and surgical intervention are:

stones in the ureters,
presence of a single kidney with a stone,
stone in the pelvis in the presence of acute pyelonephritis,
macrohematuria (blood in the urine) due to a stone that does not respond to conservative treatment,
a condition of acute urinary retention due to the presence of stones in the urinary tract.

Required knowledge

If you have kidney problems, you should be aware of the factors that provoke colic:

excess or lack of fluid in nutrition,
eating disorders,
bumpy ride
drinking alcohol,
physical, mental, mental stress,
acute respiratory or intestinal infections.

During an attack of renal colic, it is unacceptable to leave the patient without medical care. Frivolity and short-sightedness of the patient and his environment can cost him his life. When bleeding spreads rapidly throughout the abdominal cavity, it can be difficult to cope with the disease. Even if you managed to overcome the attack with home remedies, a visit to the urologist is mandatory.

1pochki.ru

Infusion therapy

There is no evidence that routine fluid resuscitation is indicated in patients with renal colic. Rather, on the contrary, active infusion therapy can contribute to an increase in intrapelvic pressure. Towards the introduction of balanced saline solutions resort if there are signs of dehydration, and enteral fluid intake is difficult for some reason.

Antibacterial therapy

Early administration of antibiotics is certainly indicated if there are signs of pyelonephritis and (or) sepsis. Antibiotics are also usually prescribed for an attack of PC that lasts several hours. III-IV generation cephalosporins (cefotaxime, ceftriaxone, cefoperazone, cefepime, cefoperazone/sulbactam) are often used as initial therapy. Ceftriaxone also has an analgesic effect.

Nausea and vomiting

For nausea and vomiting, selective blockers of serotonin 5-HT3 receptors are most effective: tropisetron 5 mg once a day IV or ondansetron 4-8 mg twice a day IV. But the high cost limits the possibility of using these drugs. Droperidol, used in a dose of 0.6-1.2 mg IV 1-3 times a day, is practically safe (almost does not prolong QT interval) and is quite effective for the treatment and prevention of PONV. If you use more high doses, risk side effects droperidol increases sharply. Dopamine receptor blocker metoclopramide hydrochloride (Cerucal), administered 10 mg 3-4 times a day intravenously.

Survey

After the pain has reduced, the patient is examined.

Laboratory methods

General blood analysis. Changes in indicators in general are not typical for renal colic. In dehydrated patients, the hemoglobin concentration and the number of red blood cells may increase.

Creatinine, urea. High rates are a contraindication for performing excretory urography and prescribing NSAIDs;

General urine analysis. Erythrocyturia occurs in approximately 80% of patients with renal colic. Leukocyturia and bacteriuria indicate the presence of a urinary tract infection.

Instrumental examination methods

Ultrasound examination of the kidneys and upper urinary tract is the most accessible method that allows identifying stones in the kidneys, upper and, in some cases, lower third of the ureter, as well as dilation of the collecting system. It should be noted that in approximately 25% of patients there are no pathological changes and expansion of the pyelocaliceal system, which requires additional methods research.

Non-contrast spiral computed tomography (CT) - this method gives the most full information about the cause of obstruction that caused the development of PC. And, at the same time, identify/exclude many diseases of the abdominal organs.

Excretory urography, until recently the “gold standard” in the diagnosis of PC, is currently performed when CT is not possible. Excretory urography can detect radiopaque stones in the urinary tract. During an attack of renal colic, when there is a segmental spasm of the pyelocaliceal or ureteric muscles with a simultaneous weakening of blood flow in the cortical zone of the renal parenchyma, the contrast agent is not secreted by the kidney, which is noted on the urogram as a sign of the so-called “silent kidney”. But if the increase in intrapelvic pressure is not so critical (65-100 mm Hg), then the images clearly reveal a nephrogram (the so-called “white kidney”), indicating the impregnation of the renal parenchyma with a contrast agent, but without its penetration into the upper urinary tract ;

Retrograde ureterography is indicated in difficult cases differential diagnosis between renal colic and diseases of the abdominal organs, when the results of spiral computed tomography and excretory urography are ambiguous.