renal colic
| Classification according to ICD-10 | |
|---|---|
| N20 | Kidney and ureteral stones |
| N23 | Unspecified renal colic |
| ICD-10 online (WHO version 2019) | |
A renal colic is a cramping pain ( colic ) in the lumbar region or the abdominal cavity ( the abdomen ).
Cause and origin
Renal colic occurs when kidney stones or kidney gravel , more rarely blood clots or dead tissue, enter one of the two ureters in the direction of the urinary bladder and this results in an acute urinary flow disorder. This is preferably done in the area of the three anatomical constrictions of the ureter:
- in the area of the renal pelvis
- Height of the crossing of the ureter over the common iliac artery (or common iliac vein )
- when the ureter enters through the wall of the urinary bladder
The sudden closure of the ureter leads to an increased formation of prostaglandins in the functional kidney tissue. The vascular resistance of the renal arteries decreases, the capillary filtration pressure in the kidney corpuscles rises with the consequence of an increased urine excretion, especially of the affected kidney. This increases the hydrostatic pressure above the obstacle, resulting in increased wall tension in the renal pelvis and ureter: this activates stretch receptors and pain receptors.
In extremely rare cases, kidney worm infestation can also trigger renal colic. However, this disease rarely occurs in Central Europe.
Symptoms
Cramp-like pain in the area of the affected kidney, often radiating in all directions on the back, usually one-sided. When it first occurs, you cannot tell yourself that the pain is originating from the kidney. Strong to unbearable pain character. Occasionally sweating and vomiting. Mostly bloody urine. Typical are phases with severe pain alternating with symptom-free times, but the pain can also have the same intensity over the long term. Acute colic is particularly uncomfortable and is often described as one of the strongest pain sensations people can feel.
Diagnosis
The urine test often reveals traces of blood, and stones are almost always the cause of colic. During the physical examination, the affected kidney bed is sensitive to knocking and the abdominal cavity is very sensitive to pressure along the affected ureter. Often decreased bowel sounds. An ultrasound examination ( sonography ) of the abdominal cavity is essential to localize the stone and to detect a congestion in the kidney . Computed tomography can be carried out for reliable diagnosis of a stone . An excretory urography (X-ray examination with contrast agent ) may also be useful for a more precise assessment of the urinary tract . Because of the diuretic effect of the contrast media, this examination may only be carried out after the colic has broken through with painkillers, as otherwise a fornix rupture can occur. In addition, retrograde pyelography can also be performed. This is an X-ray examination in which the ureters are filled with contrast medium using a catheter inserted through the urethra and bladder.
Therapy options
Traditionally, warmth (because it relieves cramps), exercise and plenty of drinking are recommended. These recommendations have not been scientifically verified. Drug treatment includes antispasmodic pain relievers such as metamizole . In severe cases, even stronger pain relievers must be used. If a stone is the cause, it can come off spontaneously or it has to be removed. The treatment options depend on the location of the stone. The procedures include litholysis by adjusting the pH of the urine in the case of uric acid stones or small cystine stones, extracorporeal shock wave lithotripsy (external shattering, ESWL), endoscopic shattering in the ureter using a ureteral mirror or endoscopic removal using forceps or a special basket, the so-called Dormia basket . Endoscopic fragmentation can be carried out using shock waves or lasers . If the kidney stone should come off itself, a ureteral splint can be used to support it. This also prevents any further backlog of urine towards the kidneys. In the case of other causes (e.g. blood clots) the cause must be investigated and then treated.
Complications
If the stone completely blocks the ureter, the urine of the affected kidney can no longer drain. In the long run, this leads to kidney damage and even complete loss of function of this kidney. If the drainage disorder is accompanied by an infection in the form of a urinary tract infection , a urinary stasis kidney with fever , chills , pain and pelvic inflammation can develop and, if left untreated, lead to death.
literature
- Michael Straub, Richard E. Hautmann: Urolithiasis - urinary stone disease. In: Richard Hautmann, Hartwig Huland (Hrsg.): Urologie. Springer, 2006, ISBN 3-540-29923-8 , pp. 260 ff.
Individual evidence
- ^ C. Tschuschke, SC Müller, L. Hertle: Pain therapy for acute renal colic. In: The pain. (1993); 7, pp. 160-166.
- ↑ Stephen W Leslie: Nephrolithiasis: Acute Renal Colic. (English; online) ( Memento of the original from December 22, 2015 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Alexander Beck: margin note - on life and death . In: German medical newspaper. 1–2 / 2012.
