RENAL COLIC. intermittent pain caused by a kidney stone

Renal colic is a severe, sudden, and intermittent pain caused by a kidney stone or other obstruction in the urinary tract

1. .
RENAL COLIC
RENAL COLIC
26-Sep-24
PRESENTED
BY
MUTEGEKI ADOLF
KSHS

2. DEFINITION:
•Renal colic is a type of severe, acute pain caused
by the obstruction of the urinary tract, typically
due to the passage of kidney stones (urolithiasis)
through the ureter.
•The pain is usually sudden and intense, radiating
from the flank to the lower abdomen or groin

3. Introduction
•T10-12, L1roots innervate the renal capsule and
ureter.
•Pain from these structures is felt in these
dermatomes.
•Urinary tract & GIT share the same autonomic
innervation, that’s why renal colic is usually
associated with GI symptoms.

5. •Site:Loin (space below 12
th
rib & iliac crest), Renal
angle (between 12
th
rib & edge of erector spinae
muscle).
•Radiation:Towards the umbilicus.
•Onset:Sudden.
•Duration:variable.
•Nature:Dull, aching pain .
•Intensity:Severe.
Renal Colic

6. •Course:constant.
•Progression:progressive.
•Relieving & Exacerbating factors:
patient tries changing his position in
bed, or walking,but usually fails to
relieve the pain. Relieved by analgesics.
•Associated Hematuria, urinary
frequency, dysuria, fever, sweating,
nausea & vomiting.

7. Renal Colic

8. •Patient usually describesthe pain by
spreading his hand around his waist with his
fingers covering the renal angle & his thumb
above the anterior superior iliac spine.
•Acute Pyelonephritis and acute
ureteral obstruction both cause
this typical pain.

11. Ureteral Colic
•Site: Originates at the costo-vertebral angle.
•Radiation: Lower quadrant of abdomen, upper thigh and ipsilateral
testicle or labium.
•Onset:Sudden.
•Duration:variable.
•Nature: colicky, gripping.
•Intensity:Severe.

12. •Course:attacks, pain is less severe in between, but
never disappears completely.
•Progression:progressive.
•Relieving & Exacerbating factors: patient tries
changing his position in bed, or walking,but usually
fails to relieve the pain. Relieved by analgesics.
•Associated Hematuria, urinary frequency, dysuria,
fever, sweating, nausea & vomiting.

15. Ureteral Colic
•Typical of sudden ureteric distension &
associated distension of the renal pelvis.
•Most commonly due to calculi.
•Less commonly due to tumor, or blood clot.

16. •Ureteral colic caused by stone in the
upper ureter may be associated with
severe pain in the ipsilateraltesticle; due
to the common innervation of these
structures (T11–12).
•Stone in the lower ureter may cause pain
referred to the scrotal wall.

17. •Stones in mid-ureter on the right side,
causes pain referred to McBurney’spoint
and may therefore simulate appendicitis.
•On left side it may resemble diverticulitis
or other diseases of the descending or
sigmoid colon (T12, L1).

18. AETIOLOGY (CAUSES):
•Renal colic is primarily caused by urinary stones(calculi)
that develop within the kidney and migrate into the ureter,
leading to obstruction and increased pressure within the
urinary system. The main causes include:
•Kidney stones(most common cause):
•Calcium stones: Often due to high calcium excretion in urine
(hypercalciuria).
•Uric acid stones: Formed due to acidic urine or hyperuricemia
(e.g., in gout).
•Struvitestones: Associated with chronic urinary tract infections
(UTIs).
•Cystinestones: Caused by a genetic disorder called cystinuria.

19. •Dehydration: Inadequate fluid intake leads to concentrated
urine, which promotes stone formation.
•Hypercalciuriaor Hyperoxaluria: Elevated levels of calcium
or oxalate in the urine increase the risk of stone formation.
•Dietary factors: High intake of salt, oxalate-rich foods (e.g.,
spinach), or animal proteins can contribute to stone
formation.
•Family history: A genetic predisposition to kidney stones
increases the likelihood of developing them.
•Metabolic disorders: Conditions such as gout,
hyperparathyroidism, and renal tubular acidosis can
increase the risk of stone formation.

20. PATHOPHYSIOLOGY:
•Renal colic occurs when a kidney stone
obstructs the flow of urine, typically within the
ureter, leading to the following sequence:
•Obstruction: A stone blocks the ureter, causing
urine to accumulate above the blockage.
•Increased pressure: This leads to increased
hydrostatic pressure in the renal pelvis and
ureter, which distends and irritates the
surrounding tissue.

21. •Pain signaling: The distension and irritation
stimulate sensory nerves, causing the characteristic
severe pain of renal colic.
•Ureteral spasm: The muscles of the ureter contract
forcefully in an attempt to dislodge the stone,
exacerbating the pain.
•Inflammatory response: The obstruction may
cause localized inflammation and edema, further
increasing pain.

22. CLINICAL PRESENTATION:
•Severe, colicky pain: The pain is typically sharp,
intermittent, and comes in waves, as the ureter
contracts to pass the stone.
•It often originates in the flank (side) and may radiate
to the lower abdomen, groin, or testicles (in men) or
labia (in women).
•Hematuria: Blood in the urine may be visible (gross
hematuria) or microscopic, due to trauma caused by
the stone moving through the urinary tract.

23. •Nausea and vomiting: Often accompany the
pain due to visceral nerve stimulation.
•Urinary symptoms: Frequent urination, urgency,
and dysuria (painful urination) may occur if the
stone reaches the bladder or urethra.
•Restlessness: Patients often move around in an
attempt to relieve the pain, as the discomfort
prevents them from finding a comfortable
position.

24. On Examination
•General examination: Agitated, in pain, pallor, fever,
tachycardia.
•Abdomen tense & rigid.
•Loin tenderness.
•Kidney enlargement.

25. INVESTIGATIONS:
•Urinalysis: To detect hematuria (blood in
urine), infection, and the presence of
crystals that may indicate the type of stone.
•Blood tests:
•Serum creatinine: To assess kidney function.
•Serum calcium, phosphate, and uric acid
levels: To identify metabolic abnormalities.

26. •Imaging:
•Non-contrast CT scan (CT KUB): The gold standard for diagnosing
renal stones, highly sensitive and specific for detecting stones in
the kidneys and ureters.
•Ultrasound: Useful for detecting hydronephrosis(swelling of the
kidney due to urine buildup) or large stones, especially in
pregnant women.
•X-ray of the abdomen (KUB): Can detect radiopaque stones but
may miss smaller or non-calcium-based stones (e.g., uric acid
stones).
•Intravenous Pyelogram(IVP): Less commonly used today but
can provide functional and anatomical information about the
urinary tract.
•KUB(Kidney, ureters and Bladder)

27. Management
•Bed rest.
•Hydration.
•Analgesia: Morphine I.M. (10-20 mg),
PethidineI.M. (100 mg).
•Anti-emetic.
•Further management according to
the cause.

28. Renal Stones Management
•On this conservative regime 60% of
all stones pass spontaneously.
•However 30% of stones do require
surgical removal whilst the remaining
10% may be followed expectantly.

29. •>90% of kidney stones are treated
by Extracorporeal Shock Wave
Lithotripsy.
•For Staghorncalculi: Percutaneous
Nephrolithotomyor conventional
open surgery (Pyelolithotomy) are
still indicated on occasion.

30. •Extracorporeal Shock Wave Lithotripsy uses shock
waves to break down kidney stones into smaller
pieces that can pass through the urinary Tract.
•Non-invasive procedure using sound waves to
break larger stones into smaller fragments that can
pass through the urinary tract.

31. Extracorporeal Shock Wave Lithotripsy

32. Surgery indicated if:
1.Large stone.
2.Infection with severe obstruction.
3.Failure of conservative measures.
4.To correct anatomical
abnormalities.

33. •Interventional Procedures:
•Ureteroscopy: Involves inserting
a thin scope through the urethra
and bladder into the ureter to
visualize and remove or break up
stones.

34. •Percutaneous Nephrolithotomy(PCNL): Surgical
removal of larger or complex stones via a small
incision in the back, directly accessing the kidney.
•Stent Placement: A ureteral stent may be placed
to bypass the obstruction and allow urine to flow
while waiting for the stone to pass or while
awaiting further treatment.
•Antibiotics: If there is evidence of infection
(e.g., fever, pyuria), antibiotics should be
administered.

35. PREVENTION:
•Increased fluid intake: Drinking enough water to produce at
least 2-2.5 liters of urine per day helps prevent stone
formation by diluting the substances in urine that form
stones.
•Dietary changes:
•Reduce intake of oxalate-rich foods (e.g., spinach, nuts,
chocolate).
•Limit salt and animal protein intake.
•Maintain a balanced intake of calcium; avoid excessive calcium
supplements.

36. •Medications:
•Thiazide diuretics: To reduce calcium in the urine.
•Potassium citrate: To increase citrate levels in urine,
which helps prevent calcium stone formation.
•Allopurinol: For those with uric acid stones or high
uric acid levels.
•Regular follow-up: For individuals with a history of
kidney stones, regular check-ups and imaging may
help monitor for recurrence

37. References:
1.Smith’s General Urology, 17
th
edition, Chapter 3, Page 30-
34.
2.Davidsons’s principles & practice of medicine.
3.Oxford handbook of urology.
4.Bates’ guide to physical examination and history taking,
10
th
edition, Chapter 11, Page 428-429.
5.Textbook of medicine, Das.
5. Browse’s introduction to the symptoms & signs of surgical
disease, Chapter 16, Page 435-436.
6. Hutchinson’s clinical methods, 22
nd
edition, Chapter 14,
Page 293.