Definition of the Disease
Renal Lithiasis (Nephrolithiasis) :
Renal lithiasis, also known as nephrolithiasis, is a condition characterized by the formation of stones in the kidneys. About 80% of patients with this condition form calcium stones, while the other main types include uric acid, struvite, and cystine stones. A stone may contain several types of components.
Symptoms of Renal Colic
Clinical Manifestations :
While some kidney stones may pass without causing symptoms, symptoms may appear when they move. The most common symptoms include:
- Pain : Renal colic (intense and sharp pain) or flank pain.
- Hematuria : Presence of blood in the urine, visible to the naked eye (macroscopic hematuria) or detected under a microscope (microscopic hematuria).
- Other symptoms : Nausea, vomiting, dysuria (pain during urination), and urinary urgency.
Nephrolithiasis can lead to persistent renal obstruction, which can cause permanent kidney damage if left untreated.
Causes
Contributory Factors :
The formation of kidney stones can be influenced by various factors, including metabolic abnormalities, dehydration, certain medical conditions, and a family history of kidney stones. Patients with a history of kidney stones are more likely to develop this condition again.
Diagnosis of Renal Colic
Nephrolithiasis should be suspected in patients presenting with typical renal colic or flank pain, with or without hematuria. The diagnosis is confirmed by:
- Basic Laboratory Tests : Evaluation of metabolic abnormalities and detection of infection.
- Imaging : Computed Tomography (CT-scan) of the abdomen and pelvis without contrast is preferred for its accuracy in detecting stones, size, location, and hydronephrosis. For pregnant women, ultrasound of the kidneys and bladder is the imaging method of choice.
Treatment of Renal Colic
Acute Management :
The initial treatment of patients with nephrolithiasis includes:
- Painkillers : Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended for managing pain rather than opioids.
- Hydration : Encourage adequate hydration to facilitate stone expulsion.
- Hospitalization : Indicated for patients unable to tolerate oral intake or those with uncontrollable pain or fever.
Urological Consultation :
An urgent consultation with a urologist is necessary for patients presenting with complications such as:
- Urinary tract infection
- Acute kidney injury
- Anuria (absence of urine)
- Persistent pain, nausea, or vomiting
In summary, renal colic is a serious condition that requires prompt evaluation and appropriate treatment to prevent renal complications. Management varies depending on the severity of symptoms and potential complications.
Source: UpToDate