Clinical Notes : Urology
50. Renal Colic

Incidence
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Peak incidence is in the summer due to dehydration
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fluid intake <1L a day greatly increases risk
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occurs in 5% to 15% of the population
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Peak incidence at age 20 to 50
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male:female 3:1
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x3 higher incidence with a +ve Family History
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Small ureteral stones (<10mm) usually pass spontaneously
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50% recurrence rate
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Diseases associated with stone formation include
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Hypercalcaemic disorders e.g. hyperparathyroidism
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Gastrointestinal disease, especially malabsorptive conditions
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After bariatric surgery
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Recurrent UTI
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Gout
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Anatomical abnormalities e.g. polycystic kidneys
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Diagnosis
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Pain
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Acute or insidious onset
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Loin, groin or loin to groin
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Abdominal examination is usually normal
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Classically “the worst pain ever”
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Unable to get comfortable
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Other possible associated symptoms
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Dysuria, freq, urgency (especially distal stones)
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Haematuria
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Negative dipstick does NOT rule out renal colic
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N&V
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Fever/ rigors
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Differential diagnosis
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AAA (Abdominal Aoertic Aneurysm) if older +/- known cardiovascular risks. (This is easily missed!)
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Appendicitis
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Ovarian pathology
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Testicular torsion
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Management
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Refer to A+E if :
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Previous AKI
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Solitary kidney or transplanted kidney
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NSAIDS first line
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Consider 100mg PR diclofenac stat for pain rather than oral or IM analgesia
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wait for 1 hr
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refer to A+E if not settled after 1 hr
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Antispasmodics (e.g. Buscopan)
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conflicting evidence
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No benefit from combining NSAID with antispasmodic
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not recommended
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Opioids if NSAID contraindicated
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less effective than NSAIDs
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α- blockers (e.g. nifedipine)
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conflicting evidence
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high doses required
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not recommended
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Prevention of recurrence (by up to 50%)
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High fluid intake to produce > 2.5L urine / 24 hours
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Reduce animal protein and avoid urate rich food (as in gout)
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No need to restrict calcium (ineffective)
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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
Renal and ureteric stones: assessment and management
NICE guideline NG118
January 2019
Guidelines on urolithiasis
European Association of Urology
2017
Nephrolithiasis
BMJ Best Practice
Last reviewed: February 2019
Last updated: September 2018



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