Nephronlithiasis

Renal colic

Epi dermiology and risk factor

10 % of population ( twice common in man )

Recurrence 50 % at 5 yrs

Peak incidence 30 -50 years of age

Clinical features

Urinary obstruction   upstream distention of ureter or  collecting  system  severe colicky pain

Writhing nerve comfortable .nausea vomiting.hematuria  (90%  microscopic) disphoresis .tachycardia. tachypnea

Occasionally gross symptomsof trigonal irritation (frequency.urgency )

Fever chills .rigors insecondary pyelonephritis

Differential diagnosis of renal colic

Acute uretheral obstruction (other causes )

UPJ obstruction sloughed papillae

Clot colic from gross hematuria

Extrinsic (eg tumour

Acute abdomen billary .bowel .pancrea.

Gynaecological –ectopic pregnancy.tortion rupture of ovarian cyst

Pyelonephritis (fever .chills .pyuria )

Radiculitis-herpes never root compression

Investigation

Screening lab

C B C_elevated W B Cin presence of fever suggest infection

Electrolyte Cr BUN_ toasses renal function

Urinary R &m ( WBC sRBC scrystal )C&S

Imaging

Non crystal spiral  CT is thestudy of choice

Abdominal ulterasoundmay demonstrate stone  or hydronephrosis

Interavenous pylogram (not used verymuch anymore

Strain all urine )stone analysis

Management

Analgesic.antimatic Iv fluidsurological consult is indicate.

Especially if stone <5mm has="" if="" infection="" o:p="" obstruction="" of="" or="" patient="" sign="">

A –blocker helpful to increase stone passage in select cases

Disposition

See admission criteria (sidebar ) most patientcanbe dischargeensure patient is stable .has adequate analgesia. And is able to tolerateoral meds. Follow up with family doctor in24 -48 hours