Clinical Notes : Urology

50. Renal Colic

Incidence

  • Peak incidence is in the summer due to dehydration

    • fluid intake <1L a day greatly increases risk

  • occurs in 5% to 15% of the population

    • Peak incidence at age 20 to 50

    • male:female 3:1

    • x3 higher incidence with a +ve Family History

  • Small ureteral stones (<10mm) usually pass spontaneously

    • 50% recurrence rate

  • Diseases associated with stone formation include

    • Hypercalcaemic disorders e.g. hyperparathyroidism

    • Gastrointestinal disease, especially malabsorptive conditions

    • After bariatric surgery

    • Recurrent UTI

    • Gout

    • Anatomical abnormalities e.g. polycystic kidneys

 

Diagnosis

  • Pain

    • Acute or insidious onset

    • Loin, groin or loin to groin

    • Abdominal examination is usually normal

    • Classically “the worst pain ever”

    • Unable to get comfortable

  • Other possible associated symptoms

    • Dysuria, freq, urgency (especially distal stones)

    • Haematuria

    • Negative dipstick does NOT rule out renal colic

    • N&V

    • Fever/ rigors

  • Differential diagnosis

    • AAA (Abdominal Aoertic Aneurysm) if older +/- known cardiovascular risks. (This is easily missed!)

    • Appendicitis

    • Ovarian pathology

    • Testicular torsion

 

Management

  • Refer to A+E if :

    • Previous AKI

    • Solitary kidney or transplanted kidney

  • NSAIDS first line

    • Consider 100mg PR diclofenac stat for pain rather than oral or IM analgesia

    • wait for 1 hr

    • refer to A+E if not settled after 1 hr

  • Antispasmodics (e.g. Buscopan)

    • conflicting evidence

    • No benefit from combining NSAID with antispasmodic

    • not recommended

  • Opioids if NSAID contraindicated

    • less effective than NSAIDs

    • α- blockers (e.g. nifedipine)

    • conflicting evidence

    • high doses required

    • not recommended

  • Prevention of recurrence (by up to 50%)

    • High fluid intake to produce > 2.5L urine / 24 hours

    • Reduce animal protein and avoid urate rich food (as in gout)

    • No need to restrict calcium (ineffective)

 
 
 
 

Therapeutic Approaches for Renal Colic in the Emergency Department: A Review Article

Samad EJ Golzari, Hassan Soleimanpour, Farzad Rahmani, Nahid Zamani Mehr, Saeid Safari, Yaghoub Heshmat, and Hanieh Ebrahimi Bakhtavar

Anesth Pain Med v.4(1). February 2014

Access

Renal and ureteric stones: assessment and management

NICE guideline NG118

January 2019

Access

Guidelines on urolithiasis

European Association of Urology

2017

Access

Nephrolithiasis

BMJ Best Practice

Last reviewed: February 2019

Last updated: September  2018

Access

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