Acute Renal Colic

Question 1

Clinical presentation of acute renal colic?

Answer 1

Abrupt onset severe unilateral abdo pain origination in loin or flank, radiate to labia or groin or testicle.
Pain lasts mins-hrs occurs in spasms.
Assoc with nausea, vomiting, haematuria, dysuria, urinary frequency.

Question 2

Risk factors for renal stone formation?

Answer 2

Men age 40-60
White people
Diet of urate, na and animal protein.
Chronic dehydration.
Obesity.
Fx.
Anatomical abnormalities of urinary tract, GI conditions

Question 3

Investigations for acute renal colic?

Answer 3

Urinalysis: Haematuria (although absence of haematuria does not exclude diagnosis), nitrates. May be normal.

Urgent non-contrast helical CT scan (within 24 hrs): preferred imaging.

Urgent renal USS in preggos or kids.

Bloods: raised WBC suggest UTI/pyelo

Question 4

Differentials for acute renal colic?

Answer 4

Renal: pyelonephritis, ureteric obstruction from clot or tumour, renal rupture.

Gynae: ectopic preggo, endometriosis, rupture/torsion of ovarian cyst, PID.

GI: appendicitis, diverticulitis, biliary colic.

CVS: ruptured AAA

Question 5

When to arrange hospital admission for suspected renal or ureteric colic?

Answer 5

Signs of systemic infection (fever, sweats) or sepsis.

If pre-existing CKD

Dehydrated and unable to take oral fluids

Uncertain diagnosis.

Question 6

Management of suspected renal or ureteric colic?

Answer 6

Offter low dose non-contrast CT within 24 hrs (or USS if preggo, child).

Pain: 1 NSAIDs, 2 iv paracetamol.

Can watch & wait.
Alpha blocker to facilitate stone passage.
Surgery.

If septic- septis 6 first, stabilise patient then deal with stone, THEN decompress with nephrostomy or retrograde stent insertion

Question 7

How to prevent recurrence of renal or ureteric stones?

Answer 7

Increase fluid intake.
Avoid carbonated drinks.
Reduce salt intake.

Consider potassium citrate for:
Young ppl with recurrent stones that are predominantly calcium oxolate.

Question 8

How to manage acute urinary retention in a man?

Answer 8

Admit urgently for catheterisation.

Alpha blocker in >65yr for recurrent eps:
alfuzosin
Start at least 24hr before remove catheter
For 2-3 post catheter

Question 9

How to manage chronic urinary retention in a man?

Answer 9

Exclude non obstructive causes of reduce urine flow like heart failure.

Check serum creatinine.
Refer for specialist assessment.

Consider regular imaging, intermittent urethral catheterixation, surgery.

Question 10

Management of renal/ureteric stones less than 5mm?

Answer 10

Watchful waiting if no signs of obstructions

Medical expulsion with tamsulosin (may be possible if stone is in distal ureter)

Question 11

Management of large (>2cm) stones?

Answer 11

Percutanous nephrolithotomy:

Retrograde urethral catheter inserted using cystoscope, calculi extracted using forceps.

Question 12

Management of renal stones in pregnant women?

Answer 12

Uteroscopy:
Also good for distal or middle ureteric stones
Can be flexible or rigid
Sometimes stents can be places during uretoscopy to prevent ureteric obstruction

Question 13

How to prevent recurrence of renal/ureteric stones?

Answer 13

Thiazide for hypercalciuria

Allopurinol or potassium citrate for uric acid stones

Advice to patients:
Increase fluid intake
Add fresh lemon juice to water, avoid carbonated drinks
Eat a balanced diet