Acute Renal Colic
The overall lifetime rate of kidney stones in the general population is approximately 12% for men
and 4% for women. Peak incidence occurs in people aged 35-45 years. When stones occur in persons in
these uncommon age groups, a metabolic workup consisting of a 24-hour urine collection and
appropriate serum laboratory testing is recommended.
Black people have a lower incidence of stones than white people
Clinical Aspects of Acute Renal Colic
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In general, smaller stones are more likely to pass spontaneously, If the stone is 4 mm or smaller,
the stone is eventually passed 90% of the time. Stones 5-7 mm generally have a 50% chance of
passing spontaneously. Calculi larger than 7 mm are unlikely to pass unassisted.
Clinical findings
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1-acute renal colic is the sudden onset of severe pain originating in the flank and radiating
inferiorly and anteriorly.
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2-Approximately 85% of all patients with renal colic demonstrate at least microscopic
hematuria
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3-pyuria, fever, leukocytosis, or bacteriuria suggests the possibility of a urinary infection
and the potential for an infected obstructed renal unit or pyonephrosis
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4-Nausea and vomiting are often associated with acute renal colic and occur in at least
50% of patients.
Imaging Studies
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Plain Abdominal Film
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Renal Ultrasound(size,operator,safe,cheap).
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Intravenous Pyelogram(clear outline)
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CT Scans
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Retrograde Pyelograms
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Magnetic Resonance Imaging?
Differential Diagnoses of Flank Pain
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Muscle pain., Radiculitis, Pelvic inflammatory disease,acute appendicitis,biliary
colic,dysmenorrhea, Ectopic or tubal pregnancy, Herpes zoster, Ovarian cyst rupture or
torsion
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Pregnancy
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Pregnancy is usually associated with a physiologic hydronephrosis
Hospitalization
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Hospital admission is clearly necessary when any of the following is present:
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1-Oral analgesics are insufficient to manage the pain.
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2-Ureteral obstruction from a stone occurs in a solitary or transplanted kidney.
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3-Ureteral obstruction from a stone occurs in the presence of a UTI, fever, sepsis, or
pyonephrosis.
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Relative indications to consider for a possible admission include comorbid conditions (eg,
diabetes), dehydration requiring prolonged intravenous fluid therapy, renal failure, or any
immunocompromised state. Larger stones (ie, >7 mm) that are unlikely to pass spontaneously
require some type of surgical procedure.
1-Medications
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Narcotics and opioids
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Nonsteroidal anti-inflammatory drugs
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Antiemetics
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Antidiuretics
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Antibiotics
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Aggressive Medical Therapy
2-Stents
3-Percutaneous nephrostomy (P.C.N.L.)
4-Extra corporial shockwave lithotripsy(E.S.W.L.)
5-uretroscopic stone fragmentation
6-open surgical stone removal
By:
Muhammed Shakir Yashar
M. Shakir