Renal colic is a severe, acute pain syndrome most commonly caused by obstruction of the urinary tract by urolithiasis. The pain typically originates in the flank and may radiate to the lower abdomen, groin, or genital region. Renal colic results from increased intraluminal pressure and ureteral smooth muscle spasm proximal to the obstruction. Nausea, vomiting, and haematuria are frequently associated symptoms. Non-contrast computed tomography is considered the imaging modality of choice for the diagnosis of renal colic. Ultrasonography may be used as an initial imaging tool, particularly in pregnant patients or those requiring radiation avoidance. Laboratory evaluation includes urinalysis to detect haematuria and blood tests to assess renal function and infection. Differential diagnosis includes other causes of acute abdominal or flank pain. Initial management focuses on pain control, hydration, and exclusion of complications such as infection or renal impairment. Definitive treatment depends on stone size, location, composition, and patient-related factors.
Renal colic – flank pain (often very severe) radiating to the groin or scrotum, associated with nausea and vomiting. Most frequent etiology is kidney or ureteral stone. Stone in the distal ureter close to the bladder can manifest with lower quadrant pain, urinary frequency, urgency and dysuria. Sometimes is etiology clot, pus, intraluminal tumour (urotelial cancer) or extraureteral tumorous compresion. Physical exam shows a constantly moving distressed patient. Costovetebral angle or lower quadrant tenderness may be present. Gross or microscopic haematuria is present in 80-90 % of patients (in case with complete obstruction there is absence of haematuria). Nausea and vomiting are often present. Acute renal colic may mimic other acute abdominal conditions.
Diagnostic evaluation: urinae examination can reveal haematuria. Serum blood examination may reveal elevation of white blood cells, CRP and creatinine. Ultrasound (US) is used to estimate the degree of urinary obstruction (dilation-hydronephrosis), also kidney stones are visible. Plain abdominal radiograph (KUB: kidneys-ureters-bladder) can distinguish radiopaque stones (calcium) from non-radiopaque stones (uric acid). The current gold standard for confirming urinary stones in patients with acute flank pain is non-contrast (low dose) computed tomography (CT).
Cave: contraindication is pregnancy. The most important is to determine whether or not urgent intervention is needed. Urgent intervention is needed in: 1. obstruction with urinary tract infection (urinalysis, microscopy, urine culture, C-reactive protein, leukocytosis) 2. obstruction with renal deterioration (serum creatinin level) 3. bilateral obstruction 4. obstruction in immunosuppresive patients 5. obstruction with refractory pain Completelly obstructed or infected dilated upper urinary tract should be invasive decompressed either by uretheral stent placement or percutaneous nephrostomy. Delay in surgical intervention can be potentially dangerous. Definitive treatment of the obstructive stone should be delayed until infection is cleared. Pharmacological treatment of renal colic include analgetic treatment - nonsteroidal anti-inflammatory drugs (NSAIDs) e.g. ketoprofen and medical expulsive therapy (MET) – which includes calcium channel blockers (e.g. e.g. nifedipim) or alpha blockers (e.g. tamsulosin). Ureteral stones smaller than 6 mm have more than 50-90 % chance of passing. Generally asymptomatic patients with stones less than 10 mm, may be observed up to 4 weeks, unless symptoms, infection and renal deterioration warrant intervention. It is important to encourage patients to strain their urine for stone passage, collect and submit the stone for chemical analysis. Risk factors for stone formation include low fluid intake, high sodium intake, low fiber diet, low fruit and vegetable intake and high intake of animal proteins. Medical conditions with increased risk of stone formation include hyperparathyroidism, inflammatory bowel disease, malabsorption disorders, chronic diarrhea, renal tubular acidosis type I and diabetes mellitus. Treatment of these conditions and excluding of risk factors are the cornerstone of metaphylaxis of urinary stones.
Treatment of stones
1.Oral stone dissolution with potassium citrate (alkalisation therapy) in uric acid stones 2. Extracorporeal shock wave lithotripsy - focuses shock ultrasound waves on the stone to desintegrate it into small fragments. 3. Ureteroscopy - insertion of flexible or semirigid ureteroscope through bladder into the ureter and renal collecting system and desintegration of the stone with laser lithotripsy or removing with endocopic baskets. 4. Percutaneous nephrolithotomy (PCNL) is method prefered for renal stones 2 cm and more in maximal diameter. Puncture of renal collecting system under radiographic guidance is performed, tract into the kidney is dilated and rigid or flexible nephroscope is inserted. Lasers, ultrasonic probe or pneumatic device is then inserted and stone is fragmented and fragments are evacuated. 5. Open or laparoscopic lithotomy are surgical procedures, when stones are removed in toto.
Courses
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Keywords: renal colic, stone, upper urinary tract obstruction, acute renal failure, anuria, renal colic, stone, upper urinary tract obstruction, acute renal failure, anuria
citation: Ľubomír Lachváč: Renal colic. Multimedia support in the education of clinical and health care disciplines :: Portal of Pavol Jozef Šafárik University in Košice Faculty of Medicine [online] , [cit. 10. 02. 2026]. Available from WWW: https://portal.lf.upjs.sk/articles.php?aid=668. ISSN 1337-7000.