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Australian Journal of General Practice Jul 2021Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a...
BACKGROUND
Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care.
OBJECTIVE
The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management.
DISCUSSION
Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required.
Topics: Diagnostic Imaging; Humans; Pain; Primary Health Care; Referral and Consultation; Renal Colic
PubMed: 34189545
DOI: 10.31128/AJGP-11-20-5751 -
Acta Medica Indonesiana Oct 2012The incidence of acute abdominal pain ranges between 5-10% of all visits at emergency department. Abdominal emergencies of hospital visits may include surgical and...
The incidence of acute abdominal pain ranges between 5-10% of all visits at emergency department. Abdominal emergencies of hospital visits may include surgical and non-surgical emergencies. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation, pancreatitis, peritonitis, salpingitis, mesenteric adenitis and renal colic. Good skills in early diagnosis require a sound knowledge of basic anatomy and physiology of gastrointestinal tract, which are reflected during history taking and particularly, physical examination of the abdomen. Advanced diagnostic approaches such as radiography and endoscopy enhance the treatment for acute abdomen including pharmacological and surgical treatment. Therapeutic endoscopy, interventional radiology treatment and therapy using adult laparoscopy are the common modalities for treating patients with acute abdomen.
Topics: Abdomen; Abdominal Pain; Acute Pain; Clinical Laboratory Techniques; Diagnosis, Differential; Diagnostic Imaging; Humans; Medical History Taking; Physical Examination
PubMed: 23314978
DOI: No ID Found -
JAMA Network Open Aug 2022Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Renal colic is described as one of the worst types of pain, and effective analgesia in the shortest possible time is of paramount importance.
OBJECTIVES
To examine whether acupuncture, as an adjunctive therapy to analgesics, could accelerate pain relief in patients with acute renal colic.
DESIGN, SETTING, AND PARTICIPANTS
This single-center, sham-controlled, randomized clinical trial was conducted in an emergency department in China between March 2020 and September 2020. Participants with acute renal colic (visual analog scale [VAS] score ≥4) due to urolithiasis were recruited. Data were analyzed from October 2020 to January 2022.
INTERVENTIONS
After diagnosis and randomization, all patients received 50 mg/2 mL of diclofenac sodium intramuscular injection immediately followed by 30-minute acupuncture or sham acupuncture.
MAIN OUTCOMES AND MEASURES
The primary outcome was the response rate at 10 minutes after needle manipulation, which was defined as the proportion of participants whose VAS score decreased by at least 50% from baseline. Secondary outcomes included response rates at 0, 5, 15, 20, 30, 45, and 60 minutes, rescue analgesia, and adverse events.
RESULTS
A total of 115 participants were screened and 80 participants (66 men [82.5%]; mean [SD] age, 45.8 [13.8] years) were enrolled, consisting of 40 per group. The response rates at 10 minutes were 77.5% (31 of 40) and 10.0% (4 of 40) in the acupuncture and sham acupuncture groups, respectively. The between-group differences were 67.5% (95% CI, 51.5% to 83.4%; P < .001). The response rates of acupuncture were also significantly higher than sham acupuncture at 0, 5, 15, 20 and 30 minutes, whereas no significant difference was detected at 45 and 60 minutes. However, there was no difference between the 2 groups in rescue analgesia rate (difference 2.5%; 95% CI -8.8% to 13.2%; P > .99). No adverse events occurred during the trial.
CONCLUSIONS AND RELEVANCE
These findings suggest that acupuncture plus intramuscular injection of diclofenac is safe and provides fast and substantial pain relief for patients with renal colic compared with sham acupuncture in the emergency setting. However, no difference in rescue analgesia was found, possibly because of the ceiling effect caused by subsequent but robust analgesia of diclofenac. Acupuncture can be considered an optional adjunctive therapy in relieving acute renal colic.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR1900025202.
Topics: Acupuncture Therapy; Diclofenac; Emergency Service, Hospital; Humans; Male; Middle Aged; Pain; Renal Colic; Urolithiasis
PubMed: 35943743
DOI: 10.1001/jamanetworkopen.2022.25735 -
The Homoeopathic Physician Apr 1894
PubMed: 37136732
DOI: No ID Found -
Prevalence of microhematuria in renal colic and urolithiasis: a systematic review and meta-analysis.BMC Urology Aug 2020This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and meta-analysis aims to investigate the prevalence of microhematuria in patients presenting with suspected acute renal colic and/or confirmed urolithiasis at the emergency department.
METHODS
A comprehensive literature search was conducted to find relevant data on prevalence of microhematuria in patients with suspected acute renal colic and/or confirmed urolithiasis. Data from each study regarding study design, patient characteristics and prevalence of microhematuria were retrieved. A random effect-model was used for the pooled analyses.
RESULTS
Forty-nine articles including 15'860 patients were selected through the literature search. The pooled microhematuria prevalence was 77% (95%CI: 73-80%) and 84% (95%CI: 80-87%) for suspected acute renal colic and confirmed urolithiasis, respectively. This proportion was much higher when the dipstick was used as diagnostic test (80 and 90% for acute renal colic and urolithiasis, respectively) compared to the microscopic urinalysis (74 and 78% for acute renal colic and urolithiasis, respectively).
CONCLUSIONS
This meta-analysis revealed a high prevalence of microhematuria in patients with acute renal colic (77%), including those with confirmed urolithiasis (84%). Intending this prevalence as sensitivity, we reached moderate values, which make microhematuria alone a poor diagnostic test for acute renal colic or urolithiasis. Microhematuria could possibly still important to assess the risk in patients with renal colic.
Topics: Hematuria; Humans; Prevalence; Renal Colic; Urolithiasis
PubMed: 32770985
DOI: 10.1186/s12894-020-00690-7 -
Central European Journal of Urology 2017Renal colic during pregnancy is a rare urgency but is one of the most common non-obstetric reasons for hospital admission. The management often means a challenge for the... (Review)
Review
INTRODUCTION
Renal colic during pregnancy is a rare urgency but is one of the most common non-obstetric reasons for hospital admission. The management often means a challenge for the urologist and gynecologist due to the complexity involved in preserving the maternal and fetal well-being.
MATERIAL AND METHODS
We performed a literature search within the PubMed database. We found 65 related articles in English. We selected 36 for this review prioritizing publications in the last two decades.
RESULTS
The anatomical and functional changes of the genitourinary system during pregnancy are well documented; also during pregnancy, there are several metabolic pro-lithogenic factors. The most common clinical presentation is flank pain accompanied by micro or macro hematuria. US provides data identifying renal obstruction shown by an increased renal resistance index. MRI allows differentiating the physiological dilatation from the pathological caused by an obstructive stone showing peripheral renal edema and renal enlargement. Low dose CT has been determined to be a safe and highly accurate imaging technique. Once the diagnosis is confirmed, the initial management of patients should be conservative. When conservative management fails the interventional treatment is mandatory, a urinary diversion of the obstructed renal unit either by a JJ stent or through a PCN catheter has to be done. The definitive management of the stone can be done in the postpartum or deferred ureteroscopy can be considered during pregnancy.
CONCLUSIONS
Renal colic during pregnancy is an uncommon urgency, so it is important for the urologist to know the management of this condition.
PubMed: 28461996
DOI: 10.5173/ceju.2017.754 -
Canadian Association of Radiologists... May 2019There has been a substantial increase in the utilization of imaging, particularly of multi-detector computed tomography (MDCT), for the evaluation of patients with... (Review)
Review
There has been a substantial increase in the utilization of imaging, particularly of multi-detector computed tomography (MDCT), for the evaluation of patients with suspected urolithiasis over the past 2 decades. While the diagnostic accuracy of computed tomography (CT) for urolithiasis is excellent, it has also resulted in substantial medical expenditures and increased ionizing radiation exposure. This is especially concerning in patients with known nephrolithiasis and in younger patients. This pictorial review will focus on recent trends and controversies in imaging of patients with suspected urolithiasis, including the current roles of ultrasound (US), MDCT, and magnetic resonance imaging, the estimated radiation dose from MDCT and dose reduction strategies, as well as imaging of suspected renal colic in pregnant patients. The current epidemiological, clinical, and practice management literature will be appraised.
Topics: Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Radiation Dosage; Renal Colic; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract; Urolithiasis
PubMed: 30853305
DOI: 10.1016/j.carj.2018.09.008 -
Developmental Period Medicine 2018Urolithiasis is a disease characterized by the presence of stones in the kidney or urinary tract. It is often detected accidentally during an ultrasound or an abdominal... (Review)
Review
Urolithiasis is a disease characterized by the presence of stones in the kidney or urinary tract. It is often detected accidentally during an ultrasound or an abdominal x-ray performed for other reasons. However, the first symptom of kidney stone disease can be severe pain called renal colic. Pain caused by a colic attack is characterized by sudden onset. In half of the cases it is associated with nausea or vomiting and can lead to hypotension and fainting. The exact location and radiation of the pain depends on the location of the stone in the urinary tract. The first most commonly performed study is abdominal ultrasound with estimation of the deposit size and evaluation of urinary tract obstruction. Alternative or complementary studies are: an abdominal x-ray where radiopaque deposits can be shown, or unenhanced helical computed tomography of the abdomen. The severity of pain depends on the individual pain threshold and on the change in hydrostatic pressure in the part of the urinary system above the obstruction. Prolonged deposition of the stone in one place causes the activation of autoregulatory mechanisms to lower the pressure of the upper urinary tract, which limits the pain. The basic treatment for renal colic is analgetic therapy. The most commonly used drugs are NSAIDs and opiates. Another important component of renal colic treatment are medications that facilitate urinary stone passage by reducing oedema or limiting urethral contractions, such as: calcium channel blockers, alpha blockers, phosphodiesterase inhibitors. Intensive hydration is not currently recommended. Patients who are unlikely to spontaneously excrete the stone are eligible for minimally invasive treatment. The risk of urolithiasis recurring is high, reaching up to 40% in 5 years and up to 50% in 10 years. However, it can be reduced by proper prevention. The paper describes the pathophysiology of pain in renal colic, the treatment methods, and the case of a boy with recurrent renal colic.
Topics: Child, Preschool; Humans; Male; Prognosis; Renal Colic
PubMed: 30281523
DOI: 10.34763/devperiodmed.20182203.265269 -
Frontiers in Pharmacology 2021Although multiple randomized controlled trials (RCTs) and systematic review and meta-analysis were performed to investigate the efficiency and safety of nonsteroidal... (Review)
Review
Although multiple randomized controlled trials (RCTs) and systematic review and meta-analysis were performed to investigate the efficiency and safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids in the treatment of acute renal colic, the therapeutic regimen of renal colic is still controversial. Therefore, the aim of this study was to derive a more concise comparison of the effectiveness and safety between NSAIDs and opioids in the treatment for patients with acute renal colic by a systematic review and meta-analysis. We searched PubMed, Embase, and Cochrane Central Register of controlled trials for seeking eligible studies. The pooled mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI) was calculated using the random effects model. The primary outcome was assessed according to the Grading of Recommendations Assessment, Development and Evaluation. A total of 18 studies involving 3,121 participants were included in the systematic review and meta-analysis. No significant difference between the NSAID and opioid groups was observed, with changes in the visual analog scale (VAS) at 0-30 min (MD = 0.79, 95% CI: -0.51, 2.10). NSAIDs in the form of intravenous administration (IV) had no better effect on the changes in the VAS at 0-30 min, when compared to opioids (MD = 1.25, 95% Cl: -4.81, 7.3). The NSAIDs group in the form of IV had no better outcome compared to the opioids group, as well as the VAS at 30 min (MD = -1.18, 95% Cl: -3.82, 1.45; MD = -2.3, 95% Cl: -5.02, 0.42, respectively). Moreover, similar results of this outcome were also seen with the VAS at 45 min (MD = -1.36, 95% Cl: -5.24, 2.52). Besides, there was a statistical difference in the incidence of later rescue (RR = 0.76, 95% CI: 0.66, 0.89), drug-related adverse events (RR = 0.44, 95% CI: 0.27, 0.71), and vomiting (RR = 0.68, 95% CI: 0.49, 0.96). There is no significant difference between the NSAIDs and opioids in the treatment of renal colic in many outcomes (e.g., the VAS over different periods using different injection methods at 30 and 60 min), which has been focused on in this study. However, the patients who were treated using NSAIDs by clinicians can benefit from fewer side effects.
PubMed: 35153734
DOI: 10.3389/fphar.2021.728908