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Renal Colic: Causes, Symptoms and Treatment

Renal colic is a sudden, severe, cramping pain in the flank and urinary tract, most commonly caused by a kidney stone blocking the flow of urine.

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Things worth knowing about "Renal Colic"

Renal colic is a sudden, severe, cramping pain in the flank and urinary tract, most commonly caused by a kidney stone blocking the flow of urine.

What is Renal Colic?

Renal colic is an acute, wave-like pain episode caused by an obstruction in the urinary tract. In the vast majority of cases, a kidney stone (nephrolithiasis) is the underlying cause, becoming lodged in the renal pelvis, ureter, or bladder and blocking the normal flow of urine. The pain is often described as one of the most intense a person can experience and typically requires immediate medical attention.

Causes

The most common cause of renal colic is a urinary stone moving through or becoming stuck in the urinary tract. Other possible causes include:

Kidney stones (calcium oxalate, uric acid, struvite, or cystine stones)
Blood clots within the ureter
Tissue fragments from kidney tumors
Inflammatory swelling or scar tissue causing ureteral narrowing
Congenital strictures of the urinary tract

Risk factors for kidney stone formation include insufficient fluid intake, a high-protein diet, obesity, metabolic disorders (such as hyperuricemia or hyperparathyroidism), and a family history of kidney stones.

Symptoms

Renal colic presents with characteristic signs and symptoms:

Severe, cramping flank pain that comes in waves and may radiate to the groin, genitals, or inner thigh
Nausea and vomiting
Blood in the urine (hematuria)
Frequent urge to urinate or burning sensation during urination
Restlessness and profuse sweating
Fever and chills (indicating a possible concurrent infection)

The pain is typically so intense that patients are unable to find a comfortable position, which helps distinguish renal colic from musculoskeletal back pain.

Diagnosis

Diagnosis of renal colic involves a combination of clinical examination, laboratory tests, and imaging:

Urinalysis: Detection of blood, white blood cells, or bacteria in the urine
Blood tests: Assessment of kidney function (creatinine, urea) and inflammatory markers (CRP, white blood cell count)
Ultrasound: A quick, radiation-free first-line imaging tool to detect stones and urinary obstruction
Low-dose CT of the abdomen: The gold standard for precise localization and sizing of kidney stones
X-ray: Useful only for calcium-containing stones

Treatment

Acute Management

During an acute attack, the primary goals are pain relief and monitoring of kidney function. Common treatments include:

Pain medications (analgesics): non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac or ibuprofen; opioids in severe cases
Antispasmodics such as butylscopolamine to relax the ureteral muscles
Adequate hydration

Stone Passage and Interventional Therapy

Many small stones (under 5 mm) pass spontaneously with urine. For larger or lodged stones, the following procedures may be used:

Extracorporeal Shock Wave Lithotripsy (ESWL): Non-invasive fragmentation of the stone using external shock waves
Ureteroscopy (URS): Endoscopic removal of the stone through the urethra and ureter
Percutaneous Nephrolithotomy (PCNL): Surgical stone removal through a small incision in the skin, used for very large stones
Medical expulsive therapy: Alpha-blockers (e.g., tamsulosin) to widen the ureter and facilitate spontaneous stone passage

Prevention

To reduce the risk of recurrent renal colic, urologists recommend:

Daily fluid intake of at least 2 to 2.5 liters
Dietary adjustments (reduced salt, oxalate, and animal protein)
Weight management
Regular urological follow-up in patients with recurrent stones

When to Seek Medical Help

Renal colic is a medical emergency when accompanied by fever, chills, or a significant decrease in urine output. In these cases, immediate medical attention is required, as an obstructed kidney can lead to permanent loss of kidney function if left untreated.

References

Turk C. et al. - EAU Guidelines on Urolithiasis. European Association of Urology, 2023. Available at: https://uroweb.org
Moe O.W. - Kidney stones: pathophysiology and medical management. The Lancet, 2006; 367(9507): 333-344.
Scales C.D. et al. - Prevalence of kidney stones in the United States. European Urology, 2012; 62(1): 160-165.

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