Renal colic: Emergency evaluation and management

Renal colic: A diagnostic and therapeutic review

“…1,2,4 Geographical and seasonal factors influence the incidence of renal calculi, which rises with mean environmental temperature and is reflected in corresponding variations in hospital admission rates. 4,7 Supersaturation of stone-forming salts in the urine initiates stone formation, however, many local and systemic factors contribute. 1,2,4,8,9 There are four predominant types of renal calculi, however, 70-75% of stones are composed of calcium oxalate or calcium phosphate and most commonly associated with idiopathic hypercalcuria.…”

“…The rate of increase of tension, rather than the absolute value, is the main determinant of pain. 3,7,11,12 Wall tension is greater in the renal pelvis than in the ureter because of the larger radius of the renal pelvis. Consequently, pain is often felt in the flank, even with distal ureteric calculi.…”

“…Classically, renal colic is characterized by sudden onset of severe pain, radiating from the flank to the groin, testis or labia, associated with haematuria, frequency, urgency and dysuria. 1,2,7 Mild to moderate flank and/or iliac fossa tenderness may be present also, without signs of peritonism. 2,4 Gross haematuria is reported in up to 30% of cases, and mild tachycardia and hyper-tension are common.…”

“…2,4 Gross haematuria is reported in up to 30% of cases, and mild tachycardia and hyper-tension are common. 2,4,7 As visceral pain is transmitted by the autonomic nervous system to the coeliac plexus, the pain may be localized poorly, and confused with pain from other intra-abdominal organs. 4 Nearly 50% of patients experience nausea and vomiting.…”

“…4 Nearly 50% of patients experience nausea and vomiting. 4,7 Abdominal distension due to paralytic ileus may occur. 7 Symptoms often reflect the site of impaction.…”