Emergency care for renal colic. Emergency care in case of an attack of renal colic, algorithm of actions. Clinical manifestations of pain syndrome

Emergency care for renal colic should be provided from the first minutes of the attack so that the patient’s condition does not lead to irreversible consequences. In addition to the fact that first aid for renal colic alleviates pain symptoms, it stabilizes the patient’s condition, which shortens the recovery period. Renal colic ranks second in the world in terms of severity of symptoms (appendicitis is first), therefore, if there is a sick person in the house, you need to know the rules of emergency care for renal pathology, the symptoms of the disease and have all the necessary drugs and devices on hand.

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 the body:

• 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;
• Narrow lumen in the ureter;
• Formations of a benign or malignant nature in the uterine region, 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 the clinical picture of the disease, emergency care for renal colic is provided based on the symptoms of the attack.

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

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

Manifestations of pain when urinating;

1. Dizziness;
2. Rapid increase in body temperature and blood pressure;
3. Nausea;

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 first aid is used to relieve pain.

Symptoms of the disease

Colic in the kidneys is a sharp attack of severe pain, provoked by a violation of the outflow of urine from the pelvis, but sometimes the reasons lie in pathological processes, for example, when stones pass away. Attacks occur both at rest and with increased physical activity, lasting from several minutes to several hours.

Overflow of urine into the renal pelvis causes increased pressure on the borders of the pelvis, kidney parenchyma, vessels and urinary channels. Main symptoms:

1. sharp unbearable pain in the area of ​​the diseased organ, from which the patient’s legs literally “give way”;
2. pain radiates to the thigh, abdomen, external genital organs, bladder;
3. very severe pain when urinating, and the nature of the pain is cutting and as if it was “baking” inside;
4. There are frequent cases of increased blood pressure and temperature;
5. a change in position threatens a painful shock, the patient cannot turn around or breathe normally;
6. tremor of the lower and upper extremities;
7. nausea and severe vomiting, as if poisoned;
8. confusion;
9. general weakness, feeling of malaise;
10. constipation, gas disturbances, bloating.

Important! Sometimes a similar clinical picture can be observed in pathologies of internal organs located next to the kidney, so emergency care techniques will be largely similar

First aid

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

First aid for renal colic 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;
• 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.

It must be remembered that it is imperative to seek help from doctors, even if emergency assistance eliminated the 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:

1. Spasmodic and did not bring relief;
2. 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:

1. 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.
2. Action to eliminate vomiting involves administering antiemetics, such as Metoclopramide.
3. As emergency medications, myotropic antispasmodics are used, which are administered simultaneously with analgesics.
4. 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.
5. 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.

At the time of 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 area begins to hurt, you need to urgently contact a medical facility to make an accurate diagnosis.

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 is a clinical syndrome that 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?

What is absolutely forbidden to do?

Despite the need to take measures to relieve spasm, there are a number of procedures that cannot be performed:

• take a very hot bath for heart problems, especially for elderly patients;
• give painkiller injections if a person is taking medications that do not interact with antispasmodics;
• give plenty of fluids if there is swelling;
• give a very hot heating pad at high temperature.

All measures of assistance are carried out taking into account the age and presence of diseases of the patient, otherwise the procedures are more likely to harm than help.

Important! If there is no confirmed diagnosis of renal colic, care is provided in the same manner, but overheating of the patient should be avoided and the temperature and pressure should be carefully monitored. Attacks of pain are accompanied not only by spasms, but also by the passage of stones from the kidney, the dynamic development of acute pyelonephritis and a host of other diseases. Therefore, nausea, vomiting, confusion and loss of consciousness are possible, which requires constant monitoring of the patient.

ㅡ one of the most severe pain attacks, radiating to the lower back. It is provoked by stones passing from the kidneys into the ureter. The attack has an increasing character or appears suddenly in the form of pain. Pain is felt not only from the affected organ, but also moves to the groin, pubic area or inner thighs.

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. 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).

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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 foci of chronic infection, the presence of systemic connective tissue diseases and urethritis.

Causes

The main cause of renal colic is impaired urine flow due to compression or blockage of the urinary canals. In the excretory system, a reflex muscle spasm occurs, pressure increases in the renal pelvis and tissue edema.

The most dangerous causes are pathologies:

1. Mechanical obstruction associated with the passage of stone through the ureter in urolithiasis (incidence of cases is about 58%).
2. Blockage of the ureter with clots of mucus or purulent discharge in complicated pyelonephritis.
3. The appearance of necrotic and caseous masses in kidney tuberculosis.
4. Twisting or bending of the ureter due to nephroptosis, malposition of the kidney, or narrowing of the ureter.
5. Exposure to tumors (renal adenocarcinoma, prostate adenoma and cancer, hematomas after injury).
6. (progressive dilatation of the renal pelvis).
7. Severe swelling of the mucous membrane with various types of urethritis, prostatitis and stagnation of blood in the peripheral veins.

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).

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.

Nausea and vomiting

For nausea and vomiting, selective blockers of serotonin 5-HT3 receptors are most effective: 5 mg once a day IV or 4-8 mg 2 times 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 the QT interval) and is quite effective for the treatment and prevention of PONV. If higher doses are used, the risk of droperidol side effects increases dramatically. Dopamine receptor blocker (Cerucal), administered 10 mg 3-4 times a day intravenously.

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).

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 excretory urography and the prescription of 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 to detect 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 no pathological changes or expansion of the collecting system are found, which requires additional research methods.

Non-contrast spiral computed tomography (CT) - this method provides the most complete information about the cause of the 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 of differential diagnosis between renal colic and diseases of the abdominal organs, when the results of spiral computed tomography and excretory urography are ambiguous.

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 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.

Causes of colic in the kidneys

The following factors influence the development of an attack:

• acute, chronic form of pyelonephritis;
• long-term urolithiasis;
• various forms of nephroptosis;
• destruction of metabolic processes in the body (water-salt, mineral);
• hydronephrosis;
• tumor formations in the kidneys;
• problems with the prostate gland (in men);
• violation of the indicated diet;
• excess or lack of fluid;
• alcohol abuse;
• physical/mental stress;
• infections.

The development of an attack of kidney disease is not always possible to determine. Colic can manifest itself both against the background of old urolithiasis, in which the canal is blocked by a stone, and as a result of an acute inflammatory process. In addition, pathology is often the result of driving on a bad road, especially if the patient already has kidney pathologies. In this case, the need for emergency care for renal colic is extremely important, so you should study the symptoms of the disease and know all the rules for pre-medical relief of the consequences of the spasm.

Important! Symptoms of colic often signal the emergence and dynamic development of a new dangerous pathology that requires urgent special care and immediate treatment. The list of diseases includes: kidney failure, malignant tumors, cyst rupture and much more.

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.

Renal colic is understood as a sudden attack. This condition is often associated with, but in fact, doctors consider renal colic to be one of the symptoms of many pathologies of the body’s urinary system.

Specialized treatment

Treatment of renal colic includes measures aimed at removing insoluble stones. This is done using several methods:

• Ultrasonic lithotripsy is a modern technique that involves exposing the stone to high-energy ultrasound, which leads to its gradual destruction. The method is effective only for certain types of stones.
• Endoscopic intervention - an endoscope (a tube with a camera, lighting and manipulators) is inserted into the lumen of the hollow structures of the urinary tract. Under visual control on a monitor screen using micromanipulators, the doctor crushes and extracts the insoluble stone.
• Open access surgery - intervention is prescribed for large sizes or numbers of stones, as well as the development of a complicated course of urolithiasis.

Regardless of the method of removing insoluble stones, drug therapy must be carried out first. It includes the prescription of antibiotics and antispasmodics.

Renal colic is a complication of urolithiasis, which is accompanied by very severe pain. In order to avoid development, timely diagnosis and treatment of pathology is necessary.

Causes of renal colic

Doctors say that the pain syndrome in question manifests itself against the background of blockage of the ureter and impaired urine flow. But the following reasons can lead to this condition:

• , moreover, only if the stone has blocked the ureter and does not allow urine to come out;
• tumors (benign or) of the kidneys - the ureter may be blocked by a blood clot or pus;
• necrotizing papillitis;
• , occurring in a purulent form;
• kidney injury;
• benign and/or malignant tumor of the ureter or bladder.

It is extremely rare that the cause of renal colic is compression of the ureter, which can occur during surgery on the pelvic organs, against the background of enlargement of nearby lymph nodes or a tumor of the retroperitoneal space.

For renal colic to occur, provoking factors are needed, since the above pathologies themselves are not characterized by pain. The provoking factors in this case are:

• long journey in a car or train (shaking);
• medications for the treatment of urolithiasis;
• a sharp limitation in the amount of fluid consumed, or, conversely, a sharp increase in this amount;
• a strong blow to the back.

If the ureter is blocked by a stone, the result will be a disruption of the outflow of urine. At the same time, new portions of urine continue to be produced in the renal tubules, there is no exit of this fluid from the body, and the renal collecting system expands. The longer the ureter is blocked, the faster the kidney vessels are compressed and its blood supply is disrupted.

Please note: the size of the stone/clot has absolutely no effect on the presence or absence of renal colic. There are cases when even a small size of a stone/clot (1-1.5 mm) provokes a powerful attack of pain.

Symptoms of renal colic

The main symptom of the condition in question is intense, sharp pain in the lumbar region. They can join:

• blood in the urine is not always observed, but if the stone in the ureter has sharp edges or is too large, then hematuria is inevitable;
• frequent urination - occurs only if there is an obstruction to the outflow of urine in the lower parts of the ureter;
• bloating;
• complete absence of urine output - occurs with bilateral renal colic or in the case of the presence of only one kidney.

Doctors emphasize that there are quite a lot of pathologies that can imitate renal colic. For example, these include torsion of an ovarian cyst in a woman, radiculitis, kidney infarction, acute pleurisy,. Therefore, in no case should you carry out independent treatment - only a specialist will be able to make an accurate diagnosis and provide qualified medical care.

Symptoms

Paroxysmal pain can easily be confused with the manifestations of other pathologies, but in the aggregate, specific symptoms point specifically to renal colic:

1. With increased urge, urination becomes difficult. Going to the toilet can be done every 20 minutes.
2. The patient exhibits general disorders - nausea, vomiting, increased gas formation and diarrhea (loose stools).
3. An attack of pain usually occurs during activity such as running, walking, jogging and playing sports. But even in a calm state, the patient often feels discomfort.
4. In a short period of time, the pain becomes unbearable, the person moves quickly, cannot stay in one position or find a position that relieves it.
5. The attack is characterized by the formation of pain in the lumbar region, then it moves from the ureters to the lower abdomen.
6. In complicated cases, renal colic is long-lasting, receding only temporarily.
7. During urination, severe pain occurs if small stones and salt come out. Urine becomes reddish due to injury to the walls of the bladder or urethra.

Other pathologies with symptoms similar to renal colic:

• ectopic pregnancy;
• appendicitis;
• acute attack of pancreatitis or cholecystitis.

The above pathologies are a threat to human health; they must be distinguished from colic. Attempts to independently relieve a pain attack should be with full confidence that it is caused by urolithiasis and not by another serious disease.

Diagnostic measures for renal colic

To find out the true causes of the pain syndrome and confirm renal colic, the patient is prescribed a number of examinations.

Physical examination

The doctor identifies pain in the area of ​​the anatomical location of the kidneys along the ureteral points. At the same time, differential diagnosis is carried out with a number of acute surgical diseases - for example, during the initial examination, a specialist will distinguish an attack of acute appendicitis from renal colic.

Ultrasonography

With this type of examination, the doctor will see the expansion of the collecting space in the kidney, stones in the ureters and kidneys and their exact location. for renal colic, it is considered quite informative, but in some cases it will not give results - for example, with an abnormal structure of the organs of the genitourinary system, or if the patient is obese.

Excretory urography

This examination method is considered the most informative and consists of radiography. First, an image of the renal system is taken, then the patient is injected into a vein with a contrast agent, which enters the urine quite quickly. After a certain period of time, the patient is given another x-ray - the doctor can assess the level of urine filling with contrast in the renal pelvis, ureter, the size of the stone and the level at which it is located in the urinary system.

Excretory urography also has contraindications - an allergy to iodine (it is contained in the contrast agent used) and thyrotoxicosis.

Contraindications and characteristics

It should be borne in mind that the bath is contraindicated for elderly people and people with diseases of the cardiovascular system who have suffered a myocardial infarction or stroke. Localized heating with dry heat or applying a heating pad is not recommended in the presence of inflammatory processes, including.

The therapeutic effect of diuretics for renal colic becomes reversed. Therefore, when the renal tubule is blocked by a stone, thrombus or edematous tissue, diuretics only aggravate the person’s condition, and the movement of the stone can cause new pain syndromes. Moreover, excess fluid load on the body will not have a positive effect.

With properly organized actions, pain and other accompanying symptoms go away quickly enough. First aid can be considered successful if the condition has stabilized, the pain has passed and the person does not feel discomfort. If you feel better, you should immediately contact a specialist. Ignoring the problem can lead to complications, possible surgical intervention and long-term rehabilitation in the future.

If independent first aid for renal colic does not bring the desired result, in this case the issue of urgent hospitalization is resolved.

If anuria (lack of urine) and elevated body temperature are observed, then hospitalization and possibly surgery will stabilize the condition.

First aid for renal colic

If the pain syndrome in question happened at home, then you need to immediately call an ambulance. Before the specialists arrive, it is permissible to take a warm bath or shower - this will reduce the intensity of renal colic.

Please note: if there is a history of pregnancy (even the shortest period), then the bath is contraindicated! Most likely, such an intense pain attack will indicate an ectopic pregnancy, and exposure to heat can lead to rupture of the fallopian tube and the release of the fertilized egg.

If the pain is unbearable, then before the specialists arrive, you can take a painkiller - for example, Baralgin or No-shpu. But this is an extremely undesirable act - such drugs “blur” the clinical picture and it will be difficult for the doctor to make a diagnosis.

Treatment of renal colic

If the patient’s diagnosis of renal colic is confirmed, then treatment will be selected. based on the etiology of the syndrome. For example, if the cause of the condition in question is urolithiasis, then it is possible to carry out. The essence of this treatment is to prescribe specific medications that accelerate the process of stone passage from the ureter. But the doctor can make such appointments only after an examination confirms the presence of a small stone. The following medications may be prescribed as part of lithokinetic therapy:

:

• antispasmodic - they not only reduce the intensity of pain, but also promote dilation of the ureter;
• alpha blockers - relax the smooth muscles of the walls of the ureter;
• non-steroidal anti-inflammatory drugs - reduce swelling of the ureter and have a good analgesic effect.

Usually, when carrying out this type of therapy, the stone leaves the ureter within 2-3 days, but if this does not happen, then doctors conduct an additional examination of the patient and decide to change the treatment tactics - prescribe. This method is considered the “gold standard” for urolithiasis - a directed beam of mechanical waves acts precisely on the stone and destroys it. This procedure is necessarily carried out under ultrasound or x-ray control, the effectiveness of such treatment is 95%.

Please note: if a stone remains in one place for a long time, this may result in the development of fibrosis of the ureter exactly at the site of its localization. Therefore, even knowing about urolithiasis, the patient should not relieve renal colic at home - taking strong medications will not change the position of the stone.

Emergency treatment

Anesthesia

Diagnostic procedures must be preceded by the elimination or reduction of pain. Most experts believe that unless there are contraindications, the best initial treatment option is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Their effectiveness is associated with inhibition of the synthesis of prostaglandin E2 in the kidneys, which helps to reduce renal blood flow and reduce urine production and intrapelvic pressure.

Due to the anti-inflammatory effect, NSAIDs reduce swelling in the occlusion area. Compared to narcotic analgesics, they are less likely to cause nausea and vomiting and do not depress breathing. But there is a certain problem - the choice of drugs that can be administered intravenously is small.

Use one of the drugs:

• (Ketonal) has a pronounced anti-inflammatory and analgesic effect. Intravenously - infusion of 100-200 mg in 100 ml of physiological sodium chloride solution for 0.5-1 hour every 8 hours;
• . More often, 75 mg of the drug is administered intramuscularly. If necessary, the injection can be repeated, but not earlier than 30-60 minutes after the first injection. Some manufacturers allow intravenous administration of diclofenac. In any case, intravenous administration is carried out in the form of a drip infusion;
• Metamizole (Analgin) has a predominantly central mechanism of analgesic action. It has an active antispasmodic effect and weak anti-inflammatory activity. 1000-2000 mg is administered intravenously, then 1000 mg 2-3 times a day.
• 30 mg IV slowly (no faster than 15 seconds) for adults under 65 years of age and children over 16 years of age. Then, if necessary, 10-30 mg every 6 hours. Has a weak anti-inflammatory effect.
• , a combined analgesic and antispasmodic agent. The combination of the components of the drug leads to a mutual enhancement of their pharmacological action. Metamizole sodium is a pyrazolone derivative that has an analgesic and antipyretic effect. Pitophenone hydrochloride has a direct myotropic effect on smooth muscles (papaverine-like effect). Phenpiverinium bromide has an m-anticholinergic effect and has an additional myotropic effect on smooth muscles. Inject slowly 2 ml intravenously. If necessary, re-introduce after 6-8 hours. The daily dose should not exceed 10 ml.

Need to remember:

• That parenteral forms of these drugs should not be used for more than 1-3 days.
• If the pain syndrome persists, therapy is continued using tablet forms of NSAIDs.
• That nonsteroidal anti-inflammatory drugs, with the exception of metamizole (Analgin), are contraindicated for destructive inflammatory bowel diseases in the acute phase, “aspirin-induced” bronchial asthma, and in the last trimester of pregnancy. In addition, they should be used with caution in patients with arterial hypertension, impaired renal function and heart failure.

If the pain syndrome is not sufficiently controlled
by taking NSAIDs, narcotic analgesics are prescribed:

• Morphine. To reduce the likelihood of side effects (respiratory depression, hypotension), 10 mg of morphine is diluted in 10 ml of 0.9% sodium chloride and administered intravenously at 2-3 ml intervals of 5 minutes, or use a dispenser;
• Trimeperidine (Promedol), unlike morphine, depresses the respiratory center to a lesser extent and is less likely to cause nausea and vomiting. Inferior to morphine in analgesic activity. Prescribe 10-20 mg intravenously, it is safer to administer in small doses.

If pain persists:

Lidocaine IV 1.5 mg/kg, administer the dose no faster than 5 minutes. Has analgesic and antispasmodic effects;

(Minirin). Taking 20 mcg of desmopressin intranasally or 200 mcg orally or as sublingual tablets provides an antidiuretic effect lasting 8-12 hours in most patients. And provides an effective reduction in intrapelvic pressure;

Preventive measures

To prevent the development of renal colic, you should follow the recommendations of specialists:

• drink at least 2.5 liters of water daily;
• maintain a balanced diet;
• limit (the best option would be to completely abandon it);
• avoid overheating;
• regularly consume cranberry and lingonberry, special urological herbal mixtures, but only after consultation with a urologist.

Renal colic is not just pain, but a “signal” from the body that there are problems in the kidneys and ureters. Even if the pain has been relieved, it is necessary to undergo an examination by a doctor and understand the cause of the condition in question, which will prevent the occurrence of renal colic in the future.

Renal colic occurs when there is a sudden obstruction in the outflow of urine from the renal pelvis (calculus, kinking of the ureter, blockage with a blood clot).

Clinical symptoms.

Sudden onset of a painful attack in the lumbar region with spread to the hypochondrium, along the ureter towards the bladder, scrotum, labia, thighs, often after physical activity, heavy drinking, for no apparent reason at night. The pain is cutting, changing in waves in intensity, with an increased urge to urinate and pain in the urethra. Accompanied by nausea, vomiting, which does not bring relief, and the urge to defecate. There may be blood in the urine (gross hematuria). Objectively, the patient’s agitation, anxiety, increased blood pressure, and tachycardia are detected. Urinalysis revealed hematuria, leukocyturia, proteinuria.

Treatment:

1) A hot heating pad on the lumbar area or a hot bath.

2) Analgesics: metamizole (analgin) 2 ml of a 50% solution intramuscularly, or baralgin 5 ml – intravenously.

3) Antispasmodics: papaverine or no-spa 1-2 ml of 2% solution intramuscularly.

Pain relievers

The drugs in this group are intended to relieve an attack and improve the flow of urine. Some analgesics and antispasmodics act within 15 minutes after administration. Typically used for colic:

• Combination drugs

They have a high effect on severe sudden dental, headache and muscle pain. They contain antispasmodic, anti-inflammatory and analgesic components. Taken orally or administered intramuscularly. A single dose is 1 tablet, but for shock pain you can take two tablets.

Spazmalgon, Revalgin, Spazgan, Baralgetas.

• Pure analgesics

Antipyretics

. The simplest group of analgesics. Their effectiveness depends on several factors - the level of the body's pain threshold, susceptibility to active components and the intensity of the pain attack. Simple analgesics in combination with paracetamol do not always help with renal colic, but if you no longer have similar stronger drugs in your home medicine cabinet, then you can take such drugs for relief. If the patient still has a fever, they will quickly reduce it.

Analgin, Tempalgin, Renalgan.

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

They not only have an analgesic effect, but also significantly inhibit inflammation and quickly reduce temperature. NSAIDs are considered more effective drugs than simple analgesics, but their abuse is extremely harmful. Treatment with most drugs in this group cannot last more than three days. If the instructions are not followed, the patient may experience side effects.

Citramon, Diclofenac, Ortofen, Citramon, Acetylsalicylic acid.

• Narcotic analgesics

This is a special group of medicines sold only as prescribed by a doctor. These include all drugs based on codeine or opium. Sometimes they are prescribed to eliminate unbearable pain and alleviate the patient’s serious condition before surgery.

Fentanyl, Promedol and Codeine.

• Pure antispasmodics

They provide relaxation of smooth muscles, which simplifies the passage of stones into the bladder. After taking the antispasmodic, the patency of the lumen of the ureter is restored. This helps relieve tension in the lower back. But to enhance the effect, you must take an analgesic along with one of the drugs.

Papaverine, No-shpa, Platyfillin.

You can also learn about help with renal colic from this video.

Renal colic occurs when there is an acute disruption of the outflow of urine from the kidney. The most common cause of renal colic is urolithiasis. When the stone is localized in the kidney, colic is observed in 50% of patients, in the ureter - in 95–98%.

Acute difficulty in the outflow of urine from the upper urinary tract leads to increased pressure in the renal pelvis and impaired blood circulation in the kidney. Thus, renal colic can lead to severe complications that pose a threat to the patient’s life, such as shock, acute purulent pyelonephritis, perinephric phlegmon, and acute renal failure.

Renal colic appears most often after physical exertion: fast walking, running, bumpy driving, sports games. The attack occurs suddenly, in the midst of complete health. The duration of the attack ranges from several minutes to a day or more. The pain is so intense and sharp that the patient rushes about and, unable to find a place for himself, takes a wide variety of forced positions to calm the pain. More often he tries to bend over, placing his hand on the lumbar region, in which he feels unbearable pain. The pain can spread to the abdomen, thigh, and genitals. Colic is often accompanied by increased urination and vomiting, which occurs due to pain and does not improve the condition. When urinating after an attack, stones may pass.

Renal colic requires emergency medical care and urgent hospitalization of the patient.

Self-diagnosis is fraught with dangerous consequences. Renal colic is easily confused with acute appendicitis and such equally serious diseases as perforated gastric ulcer, inflammation of the appendages, intestinal obstruction, intestinal infarction, and acute cholecystitis.

In the hospital, an examination is carried out, which consists of urine and blood tests, ultrasound examination of the kidneys and bladder. If necessary, an X-ray examination is performed. After this, treatment is prescribed.

First aid for renal colic

may be necessary because the pain is very severe.

Necessary:

• Call an ambulance
  .
• Place the patient in a warm bath
  to relieve pain.
  If a bath is contraindicated or is not tolerated by the patient, you can apply a heating pad to the lumbar area.
  When you feel the urge to urinate, immediately empty your bladder.
• Take antispasmodics:
  No-Shpu (Drotaverine, Papaverine).
• If there is colic on the left
  (important!), then you can take
  a painkiller,
  for example, baralgin, ketanov.
  If pain occurs on the right side
  (right-sided renal colic), then painkillers do not need to be taken, since the cause of pain may not necessarily be a kidney stone, but also appendicitis and other acute surgical diseases. In this case, taking an anesthetic drug will make it difficult to diagnose these diseases.

When is hospitalization required for a patient with renal colic:

• if after taking medications the pain does not go away;
• in the absence of urine, incessant vomiting, high temperature, etc.;
• if the pain bothers you on both sides;
• if the patient has only one kidney.

If you consult a doctor in a timely manner, in any case, the prognosis will be favorable, and you will soon forget about the terrible pain. Good health to you!

Vasily ERMAKOVICH,
urologist of the surgical department of the Central Medical Unit No. 91.
Renal colic (RC) develops as a result of an acute violation of the outflow of urine through the upper urinary tract - the renal collecting system and the ureter. Although we often associate PC with urolithiasis, the causes of impaired urine outflow can be very different: tumor process, inflammation, papillary necrosis, etc.

In response to increased intrarenal pressure, the interstitial cells of the renal medulla release prostaglandin E2, which in turn increases renal blood flow to maintain the glomerular filtration rate. Which leads to a further increase in intrapelvic pressure and the development of pain. Stretching of the upper urinary tract stimulates contraction of the smooth muscle fibers of the ureter, which will vigorously cease to move to advance the obstruction that caused the obstruction. These prolonged muscle contractions lead to a buildup of lactic acid, which stimulates pain receptors. Renal colic is characterized by acute, unbearable pain in the kidney area. The pain can radiate to the back, groin, iliac region, causing the patient to rush around and change body position.

In most cases, pain is accompanied by nausea and vomiting, which makes it impossible to take enteral medications, and in some cases leads to significant dehydration of the patient. Also characteristic is a combination of pain with the urge to urinate and gross hematuria.

20. Emergency care for hyperglycemic (ketoacidotic) coma in patients with diabetes mellitus

Hyperglycemic (diabetic) coma develops when there is a deficiency of insulin as a consequence of the inability to absorb glucose as an energy source. As a result, lipolysis increases, which leads to ketoacidosis.

Clinical symptoms

. Characterized by gradual development: moderate ketoacidosis, precoma, coma. Complaints (with preserved consciousness) of weakness, thirst, lack of appetite, nausea, vomiting, frequent urination, vague abdominal pain. Objectively: lethargy in precoma, lack of consciousness - in coma; smell of acetone, breathing is noisy, rapid, with prolonged exhalation and a pause before inhalation (Kussmaul breathing); dry skin and mucous membranes, turgor, elasticity, skin temperature are reduced; the tongue is crimson, coated; pulse is rapid, weak filling and tension; blood pressure is reduced; the stomach is swollen, tense, and may be painful. Complete blood count: leukocytosis with a shift to the left, accelerated ESR. Biochemical blood test: hyperglycemia. General urine analysis: glucosuria, proteinuria, ketonuria.

Treatment:

1) Oxygen therapy.

2) Rehydration: sodium chloride 0.9% solution 1 liter per hour up to 5 - 6 liters per day.

3) Insulin therapy is not carried out at the prehospital stage.

Insulin therapy in a hospital setting:

Short-acting insulin 8 - 10 units intravenously in a stream, and then 12 - 16 units per hour intravenously in a 0.9% solution of sodium chloride (1 l).

When glycemia decreases by 20% - short-acting insulin 8 - 12 units per hour intravenously in a 0.9% sodium chloride solution (1 l).

When glycemia decreases to 15 - 16 mmol/l - short-acting insulin 4 - 8 units per hour intravenously in a 5% glucose solution (500 ml).

When glycemia decreases to 11 mmol/l - short-acting insulin 4 - 6 units subcutaneously every 4 hours.

Intramuscular injection of insulin is allowed (into the deltoid muscle): the first injection is 20 units, then 6 - 8 units every hour until the glycemia reaches 11.0 mmol/l.

4) As glycemia decreases in the hospital: potassium chloride 5 - 10 ml of 10% solution intravenously (added to every 500 ml of 5% glucose solution).

5) For arterial hypotension - 5 ml of 0.5% dopamine solution with 5% glucose solution or 0.9% sodium chloride solution (400 ml) intravenously.

June 15, 2020 Doctor

If a person experiences renal colic, his well-being is seriously affected. A strong pain syndrome appears, sometimes it becomes simply unbearable. How to relieve pain? There are many methods, but it is important to use only those that will not harm and will be aimed at treating the underlying disease.

First aid

If a painful attack develops, you should urgently call an ambulance. Patients, as a rule, are taken to a hospital, and after acute colic is relieved, treatment is carried out at home. Before the medical team arrives, you should try to alleviate the patient’s suffering by relieving pain. Pre-medical care is allowed to be provided to a person with left-sided colic and with a history of renal pathologies, when there is no doubt about the diagnosis. If right-sided colic occurs, the diagnosis of inflammation of the appendix should be excluded before taking any medications.

To reduce the severity of the attack, the following measures are allowed:

1. Strengthen your drinking regime.
2. Apply a warm heating pad, a bottle, a bag of sand to the lumbar area (allowed only for repeated colic against the background of the movement of a large stone when the diagnosis has been established). You can also take a hot sitz bath for 10-15 minutes.
3. Give the patient painkillers or antispasmodics to relax smooth muscles, against inflammation and acute pain. Baralgin, Papaverine, No-shpa, Revalgin tablets help well. If there is a health care worker in the family, you can administer the same drugs intramuscularly.
4. In the absence of these drugs, it is allowed to dissolve a Nitroglycerin tablet to relieve the pain of an attack.

What should not be done as first aid measures? It is forbidden to take large doses of analgesics, especially if they do not have the desired effect. Also, you should not heat the lumbar area for a long time; it is better to carry out a short thermal procedure, and then apply dry heat to your back (wrap it with a scarf, handkerchief). Any heating is prohibited if there is an elevated body temperature, because in this case the cause of the disease is the inflammatory process.

First aid algorithm

To provide first aid you need:

1. The patient must be provided with complete rest. When there is pain, there is a desire to move the position of the body in search of relief, but any physical activity only worsens the condition.
2. Renal colic quickly resolves with thermal treatment. The best option is dry heating of the lumbar area. It is necessary to fill the heating pad with hot water and apply it through a dry cotton cloth in the lumbar or abdominal area.
3. A hot bath is an excellent substitute for dry heat. It relaxes smooth muscles, which helps relieve spasms.
4. Heat alone is not enough to stop an attack. Painkillers can help relieve colic. But some of them are poorly effective for such pain syndrome.

Treatment in hospital and at home

There are a number of indications for hospitalization and treatment in a hospital:

• renal colic on both sides;
• a seizure in a child or pregnant woman;
• having only one kidney;
• lack of effect from home therapy;
• elderly age;
• presence of complications;
• development of colic against the background of pyelonephritis, tumors;
• the appearance of frequent, severe vomiting;
• a sharp increase in body temperature;
• lack of urination.

To relieve an attack, medications are administered in injections, using the above-mentioned antispasmodics, non-narcotic analgesics (a mixture of Novocaine with glucose, Pipolfen, Halidor, Atropine, Diphenhydramine, Diclofenac, Ketonal, Promedol, Platyfillin, Maxigan). You can use non-steroidal anti-inflammatory drugs in tablets and suppositories.

The use of painkillers and medications for smooth muscle spasms is continued until the stone passes and the patient’s condition improves. Antibiotics are prescribed if the cause of colic is an inflammatory process, or it occurs against the background of pyelonephritis. If there is no effect of medications and acute urinary retention, ureteral catheterization is performed. Often you have to do emergency surgery (endoscopic or abdominal methods) to remove the stone.

As the attack subsides and the patient’s health returns to normal, the patient is discharged. A further course of therapy must be carried out at home. It may include the following drugs:

1. Means for optimizing blood circulation in the renal vessels - Pentoxifylline, Trental.
2. Uroantiseptics for relieving inflammation - Furomag, Nitroxoline.
3. Medicines to improve the functioning of the entire urinary system and dissolve stones - Olimetin, Urocholum, Litovit, Uro-Vaxom, Canephron, Cyston.

Methods for eliminating pain syndrome

First aid to a patient with renal colic is of great importance and may include the use of unconventional remedies. But they must be used with caution. Even if they helped, it is a mistake to think that the disease has gone away. It is imperative to go to a specialist and undergo adequate treatment.

Alternative remedies

Medicinal plants are good for renal colic. They eliminate pain, swelling and spasms. Among the most popular recipes are:

1. Carrot seeds - pour boiling water, leave for twenty-four hours, then drink up to five times a day.
2. Lingonberry leaf - prepare a decoction in a water bath, add a spoonful of honey. Use three times a day to quickly dissolve stones.
3. Grated horseradish - eat one teaspoon before meals.
4. Black radish juice with honey - drink every two hours.
5. A decoction of birch leaves - boil the raw material for twenty minutes and drink hot.
6. Onion juice - take a spoon several times a day. It perfectly dissolves and removes stones from the body.
7. Oat straw - compresses are made from it and applied to the affected area. Heat reduces swelling and eliminates other unpleasant symptoms.

Symptoms of renal colic are similar to those of appendicitis, gastric ulcers, intestinal obstruction, pancreatitis and other pathological conditions. Therefore, it is important to know an accurate diagnosis, since certain herbs can cause significant harm to the body.

Specialized medical care

Only a urologist or surgeon can competently carry out the necessary therapeutic measures and make a diagnosis. But usually the pain occurs suddenly, so they are performed by emergency doctors. After examining the patient, the doctor sends him to the hospital. Hospitalization is necessary in the following cases:

• lack of effect from taking antispasmodics and painkillers,
• development of infection due to blockage of the ureters,
• temperature rise above thirty-nine degrees.

First aid involves:

1. Administration of drugs to relieve pain. As a rule, they are administered intravenously or intramuscularly. At the same time, the patient is given myotropic antispasmodics.
2. If the first method is ineffective, narcotic painkillers are indicated - Codeine, Morphine in combination with Atropine injections.
3. If there are stones in the kidneys, the patient is given drugs whose action is aimed at dissolving and subsequent removal of the stones.

After the acute pain is relieved, the patient is sent to the hospital for an accurate diagnosis. Then a comprehensive treatment is carried out aimed at eliminating the root cause of the pathology.

Some patients are indicated for surgical intervention. As a rule, it is carried out in the presence of complications such as:

• hydronephrosis of the kidney,
• organ shrinkage,
• identification of large stones blocking the ureter.

A patient diagnosed with renal colic must follow a strict diet. The best option is steamed dishes and warm pureed food. Smoked foods, pickles, spicy and fatty foods, carbonated drinks, alcohol, strong tea and coffee are prohibited. Light soups prepared with vegetable broth, jelly, yogurt, and porridge are useful. Water and herbal teas can be consumed only on the recommendation of a doctor, since the volume of liquid is prescribed taking into account the degree of blockage of the urinary ducts.

Folk recipes

Any traditional methods of therapy are allowed to be used only with the approval of a doctor. Renal colic can accompany serious diseases of the urinary system, which are dangerous and sometimes lead to death. It is important not to delay treatment in a hospital, relying on folk remedies.

Stories from our readers

“I was able to cure my KIDNEYS with the help of a simple remedy, which I learned about from an article by a UROLOGIST with 24 years of experience, Pushkar D.Yu...”

The following recipes exist:

1. Brew a glass of horsetail herb in 2 liters of boiling water, leave for 2 hours. Strain and pour into a warm bath. Take a bath for 15 minutes.
2. You need to eat watermelons (300-700 g per day), as this product has a diuretic effect and relieves attacks of colic - removes stones from the ureter.
3. For acute pain, take a cabbage leaf and crush it in your hands. Wrap the area of ​​the affected kidney with a warm cloth and leave until the condition improves.
4. Brew a tablespoon of birch buds with 300 ml of boiling water, leave for an hour. Drink 100 ml of infusion three times a day. It is advisable to use this therapy over a course of 7-10 days.

Prevention of pathology

To no longer suffer from painful symptoms, you should follow your doctor's recommendations for the treatment of all kidney diseases. It is necessary to find out the reasons for the appearance of kidney stones and influence them with the help of drugs and diet. In the absence of contraindications, the water regime should be increased. Salt in the diet should not exceed the amount allowed by the doctor. Also, as a preventative measure, you should give up smoking and alcohol, lead an active lifestyle, and avoid hypothermia and the appearance of foci of infection in the body. In this case, the risk of exacerbation of kidney disease will be minimal.

Further treatment

The results of the examination will determine the tactics of further treatment. The patient needs specialized urological care. Emergency surgical intervention for PC is recommended in four cases: with the development of purulent complications, obstruction of a single kidney, bilateral obstruction, and intractable pain. Conservative treatment is possible if the stone diameter is less than 7-10 mm. The rate of stone passage can be accelerated by the use of drugs that relax the smooth muscles of the renal pelvis and ureter.

The most effective drugs in this regard are alpha-1 adrenergic blockers: (Omnic) selectively blocks postsynaptic alpha-1A adrenergic receptors, causing hypotension less often than non-selective drugs. In addition, it is able to block the transmission of pain impulses along C-type nerve fibers and reduce pain. Take orally (with a sufficient amount of water) 0.4 mg/day.

Terazosin (Cornam, Setegis) and doxazosin (Cardura), non-selective alpha-1 blockers, have comparable efficacy to tamsulosin. Reception begins with a dose of 1 mg. After administration, especially the first one, the patient should remain in a horizontal position for several hours. The dose is increased to 4 mg/day over a few days. The course lasts on average 10-14 days.

In the absence of alpha-adrenolytics, calcium antagonists are prescribed for the same purpose, in particular, long-acting nifedipine. Take retard forms of nifedipine at a dose of 20-40 mg 2 times a day for 7-10 days.

Corticosteroids can reduce inflammation at the site of contact of the stone with the ureter and facilitate its evacuation. Prednisolone is prescribed at a dose of 20 mg twice daily orally, as an addition to alpha-1 blockers or calcium antagonists in cases where the passage of stone(s) has slowed down.

(No-Shpa) selectively blocks phosphodiesterase, which is found in smooth muscle cells of various organs. This leads to an increase in the concentration of cyclic adenosine monophosphate (cAMP) and relaxation of smooth muscle fibers. Drotaverine is quite effective in reducing pain in PC. There is evidence that the prescription facilitates the passage of even large stones. Adults are prescribed 40-80 mg (1-2 tablets) orally 2-3 times a day. The maximum daily dose is 240 mg. The drug is widely used for PC in our country and the CIS countries, and extremely limitedly in other countries of the world.

In case of renal colic, emergency care algorithm should be clear and consistent. This allows you to minimize the risks of complications and other pathological processes, alleviate the patient’s condition and speed up recovery. However, first of all, it is worth saying a few words about what this condition is.

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