Published in Panorama
Managing Renal Colic
The pain in Abdul’s abdominal region, though intermittent, was excruciating. No matter the posture he assumed, he found no relief from changing positions. He was diagnosed as suffering from renal colic, one of the commonest problems in the Gulf, according to Dr.Mohammed Zaheeruddin, General Surgeon, Dr.Moopen’s Poly Clinic, Deira. “Weather conditions and dietary habits may play a contributory role in the condition. In addition, the intense heat in the region causes water loss from sweating and this loss is not replenished by taking enough fluids. This fluid imbalance is a common cause for stone formation in the ureter and kidney which is one factor causing the colicky pains.”
Stones in the kidneys or urinary passage, infection in the urinary tract, clot formation and tumours in the kidney or ureter, are the commonest cause of renal colic. Almost 70% of people with stone formation come up with calcium-containing stones. The other stones include magnesium, phosphate, ammonium, uric acid and very rarely, cystine stones.
The stones themselves may be caused by one or more factors. These include urinary tract infection, absence of free flow of urine for a long time due to some obstruction, prolonged immobilization of patient, sedentary lifestyle and hormonal factors. The stones may be associated with high calcium or uric acid levels in the blood and less commonly with blood in the urine or Haematuria.
What are the symptoms of renal colic? Dr.Zaheeruddin explains, “The pain, from the ‘loin to groin’, associated with renal colic is very severe and excruciating. The patient typically complains of pain in the lower back, in the region of the kidney or along the side of the ureter. He often describes the pain as coming from the back to the front and sometimes this pain can extend to the genitals in both men and women. Often you will find the patient rolling on the bed, unable to bear the pain. And very often, patients treat themselves with analgesics or painkillers. When this happens, over a long period of time, the pain assumes a chronic nature and gets established as a dull ache in the back. It is important for patients to realize that painkillers, though may give instant relief, initially, they do not solve the problem. If appropriate and timely treatment is not taken, there may be extensive damage to the kidneys.”
The other symptoms of renal colic include the presence of blood in the urine, especially when there are stones in the kidney or bladder. “Sometimes the stones are present for quite a long time (silent stones), for years together and the patient will not show up any symptoms whatsoever. This gets picked up occasionally on routine examination when patients come to us for some other problem,” reveals Dr.Zaheeruddin. “And by then, there may already be damage to the kidneys!
In some instances there may be nausea, vomiting, restlessness and increased frequency of urination and discomfort during urination. Fever may be present when the condition is complicated by infection.
Stone formation and renal colic is usually observed in individuals between the ages of 25 – 50; there may be a hereditary factor to it and its incidence is slightly higher in males than in females, reveals Dr.Zaheeruddin.
Can the symptoms of renal colic mimic symptoms of other disease conditions? Yes, though in most instances the nature of the pain will lead us to a near conclusive diagnosis, we do need to rule out certain conditions like Appendicitis, salpingitis, pyelonephritis, ovarian torsion, prostatitis, and ectopic pregnancy in women.
What are the diagnostic measures undertaken to confirm renal colic? Clinical presentation is most important, says Dr.Zaheeruddin. “Urine analysis is done. If we see crystalline substances like crystal urea in the urine, we know the patient definitely shows tendency for stone formation. And crystal urea will certainly be present in people who are not sufficiently hydrated and therefore pass concentrated urine. The urine analysis will show up some red blood cells if some damage has already occurred to the kidneys. This again is an indication of stones in the urinary tract. Of course, there are other conditions also in which all these presentations can be there; but associating these findings with the type of pain described by the patient, we are fairly sure the problem is one of renal colic.”
Radiography or X ray and ultrasound scan can easily pick up any stones in the kidney, bladder or ureter. Besides, Urography is a very important investigation, reveals the doctor. “This shows the complete outline of the kidney, ureter and bladder. This test enables us to know how well the kidneys are functioning, whether there is any damage to them and also the extent of damage, if any. Most of the times, with a combination of ultrasound and urography, we can pick up the problem. However, when in doubt, which happens very rarely, we may do a cystoscopy.”
A good sign in the Gulf region is that, most often than not, patients present with the problem in its initial stage itself, making treatment that much easier, opines Dr.Zaheeruddin. “Non-steroidal, anti-inflammatory drugs are the initial, conservative management of the problem. If patients find no relief with these, we go in for opiates. Most patients do respond to the conservative treatment. The most important aspect in treatment of renal colic is that patients should have ample fluids to flush out the crystals and small stones.”
Surgical procedures are advised, depending on the site and size of the stones, says Dr.Zaheeruddin. “ If the colic is on account of stones which are already big and cannot get flushed out in the urine, endoscopy is done. Alternatively, Nephrolithotomy which involves passing hollow tubes with wires within them to remove the stones, is undertaken. The more recent methods of treatment include using Extra Corporeal Shock Waves and Lithotripsy to crush the stone and expel the fragmented pieces through the urine. These are all daycare procedures where patients are usually admitted for a single day.”
When renal colic is on account of urinary tract infection, clots or tumours in the region, these underlying causes are appropriately treated.
What complications can untreated stones lead to? Dr.Zaheeruddin in unequivocal on this: “If there is no timely intervention and the stones are left untreated, they cause obstruction to the flow of urine. There will be a back pressure on the kidney/s and the kidney/s will slowly start getting damaged. However, stone formation and renal colic can be easily picked up in the initial stages itself when treatment is easy. Most often, increased fluid intake and avoidance of certain stone-inducing items of food, is all that may be needed to relieve the problem.”