What is Renal Colic?

During the medical examination, hitting the lumbar area with the fist increases the pain (percussion). The patient is usually anxious, uncomfortable and restless when this exploration is carried out, and they often demand analgesic treatment to reduce this pain. It can be accompanied by nausea, vomiting, paleness, sweating, and a feeling of wanting to urinate.

The most urgent therapy in the acute phase is analgesia. The drugs of choice are non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac sodium, dexketoprofen trometamol, ibuprofen, ketorolac, metamizole or paracetamol. 

Other possible medications include opiates, spasmolytics, antiemetics (metoclopramide helps control nausea and vomiting), or anxiolytics (benzodiazepines to control agitation and tachycardia caused by pain).

It is important to know that during the acute phase, fluid intake should be restricted. 

Once the symptoms have been properly controlled in the emergency department, home treatment should be followed.

A physical, effective and user-friendly way of relieving the pain is by applying local heat as a complementary treatment to pharmaceuticals. 

Generally, once the acute phase of the colic has passed, forced liquid intake is usually recommended to accelerate the passing of the kidney stone. However, further studies are needed to determine the effectiveness of this measure. Some drugs are used as a medical expulsion treatment to promote the passing of the stone, including alpha-blockers, calcium-antagonists and corticoids.

In most cases, the acute phase resolves favourably and then, together with maintenance treatment and home support measures, an outpatient urological study is indicated.

However, there are special situations in which the obstruction of the urinary tract by the stone causes infection, sepsis, anuria (absence of urine due to bilateral or unilateral obstruction in patients with only one kidney), and requires urgent and invasive measures such as ureteral catheterisation (placement of a catheter at the level of the ureter from the bladder to the kidney to drain the urine), or percutaneous nephrostomy (a catheter placed in the kidney via percutaneous lumbar puncture) to drain the obstructed urinary tract, together with antibiotic treatment. A complete blockage without drainage, from 4-6 weeks, can affect kidney function.