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renal colic; renal pain; ureteral spasm

Also see urinary calculus (nephrolithiasis) Etiology: - impaction or passage of a stone in the ureter or renal pelvis Clinical manifestations: - severe spasmodic abdominal pain - pain may be constant - often radiates to the groin - cessation of ureteral colic associated with passage of stone in 75% of cases; ureteral stone(s) persist in 25% of cases [7] Radiology: - ultrasound initial diagnostic test [4] - CT urography provides more detail at higher dost & radiation exposure Management: - analgesics: a) NSAIDs may be preferable to opiates [2] - ketorolac or diclofenac IM [6] b) intravenous morphine plus ketorolac [3] - prognosis - only 1 in 8 patients presenting to emergency department with renal colic undergo urologic procedure within 2 months [8] - only 1 in 20 patients presenting to emergency department with renal colic return to emergency department within 1 week [8] - for stones < 9 mm, at 1 month - 20% of patients had persisting ureteral stones - ~1/2 of the 20% had neither hydronephrosis nor pain [9]

Related

urinary calculus (stone, nephrolithiasis, urolithiasis)

General

colic kidney disease; renal disease

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Journal Watch 24(16):125, 2004 Holdgate A, Pollock T. Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ. 2004 Jun 12;328(7453):1401. Epub 2004 Jun 03. Review. PMID: 15178585 http://bmj.bmjjournals.com/cgi/content/full/328/7453/1401
  3. Safdar B, Degutis LC, Landry K, Vedere SR, Moscovitz HC, D'Onofrio G. Intravenous morphine plus ketorolac is superior to either drug alone for treatment of acute renal colic. Ann Emerg Med. 2006 Aug;48(2):173-81, 181.e1. PMID: 16953530
  4. Smith-Bindman R et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med 2014 Sep 18; 371:1100. PMID: 25229916 http://www.nejm.org/doi/full/10.1056/NEJMoa1404446
  5. Bultitude M, Rees J. Management of renal colic. BMJ 2012;345:e5499 PMID: 22932919
  6. Pathan SA et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: A double-blind, multigroup, randomised controlled trial. Lancet 2016 Mar 15; PMID: 26993881 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2900652-8/abstract
  7. Hernandez N et al. Cessation of ureteral colic does not necessarily mean that a ureteral stone has been expelled. J Urol 2018 Apr; 199:1011. PMID: 29107030 http://www.jurology.com/article/S0022-5347(17)77794-4/fulltext
  8. Schoenfeld EM, Shieh MS, Pekow PS et al. Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic. JAMA Netw Open 2019 Dec 2; 2:e1916454 PMID: 31790565 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2756110
  9. Jackman SV et al. Resolution of hydronephrosis and pain to predict stone passage for patients with acute renal colic. Urology 2022 Jan; 159:48. PMID: 34627871 Clinical Trial. https://www.goldjournal.net/article/S0090-4295(21)00904-3/fulltext