Renal colic
What is renal colic?
Renal colic is an acute, sudden and intense pain, most often due to the migration of a urinary calculus (lithiasis) that blocks the flow of urine, usually in the ureter.
It is a frequent urological emergency requiring rapid diagnosis and appropriate management to relieve pain and avoid complications.
Dr Sébastien Dominique, urological surgeon in Paris, manages renal colic at all stages, from diagnosis to treatment, including complications and recurrences.
Warning symptoms
1️⃣ Severe back pain or renal colic
The pain is characteristic:
- Occurs suddenly, often without any precipitating factor.
- Localized to the flank or lumbar region, on one side only (unilateral).
- Irradiates towards the lower abdomen, groin or genitals.
- Sometimes described as one of the most violent pains a patient can feel.
- It evolves in (paroxysmal) attacks, interspersed with periods of calm.
2️⃣ Blood in urine (hematuria)
- Irritation of the urinary mucosa by the stone can lead to hematuria, which may or may not be visible to the naked eye.
- It may accompany pain or be isolated
- This sign should always be investigated to rule out other causes.
3️⃣ Acute unilateral pain radiating to the lower abdomen
- Pain follows the path of the stone, from the kidney to the bladder
- It classically descends to the iliac fossa, pelvic region or groin.
4️⃣ Associated nausea and vomiting
- These signs are frequent during attacks and are linked to the intense pain.
- They may give rise to false suspicions of a digestive origin (appendicitis, colitis, etc.).
5️⃣ Difficulty urinating or absence of urine (anuria)
- In the event of complete blockage of the ureter (obstruction), urine production may be greatly reduced or absent
- Anuria is a severity criterion warranting emergency evaluation
Diagnosis of renal colic
Diagnosis is based on a combination of clinical signs and additional tests:
1️⃣ Clinical examination
- Painful lumbar palpation
- Check for fever, blood pressure, associated digestive disorders
- Assessment of context: history of stones, similar episodes, diet, hydration, etc.
2️⃣ Medical imaging
- Injection-free abdominal-pelvic CT (Uro-CT ): the reference examination
- Allows you to locate the calculation and estimate its size, density and position.
- Assess impact on urinary tract (dilatation, obstruction, renal repercussions)
- Allows you to locate the calculation and estimate its size, density and position.
- Renal and bladder ultrasound: an alternative when CT is contraindicated, especially in pregnant women
- Abdominal X-ray (ASP): used in certain cases for radiopaque stones
3️⃣ Biological analysis
- ECBU (urine cytobacteriological examination): to detect an associated infection
- Renal tests (creatinine, urea) : to assess kidney function
- CBC, CRP: to detect inflammation or infection
Management of renal colic
Management depends on several criteria: intensity of pain, size and location of stone, kidney condition, presence of infection or complications.
1️⃣ Initial medical treatment
- Strong analgesics (NSAIDs, morphine if necessary)
- Antispasmodics
- Appropriate hydration (in the absence of vomiting or severe obstruction)
- Rest and progress monitoring
2️⃣ Outpatient monitoring
If the stone is small (<5 mm) and without any signs of seriousness, it can be expelled naturally. A follow-up is set up with imaging and urine monitoring.
3️⃣ Intervention in the event of complication or failure of medical treatment
In the event of a large stone, failure of medical treatment, or complication (severe obstruction, infection, single kidney, etc.), surgery is proposed:
- Ureteroscopy: stone removal or natural laser fragmentation
- Placement of a double J catheter : for emergency kidney drainage
- Percutaneous nephrostomy: if the natural route is inaccessible or in cases of severe infection
- Extracorporeal lithotripsy (shock waves): possible depending on size and location of stone
Recurrence prevention
Renal colic can recur. Preventive management is therefore essential:
- Metabolic workup (blood and urine analysis) to identify causes of stone formation
- Dietary advice adapted to the patient’s profile
- Abundant hydration (> 2 liters of water per day)
- Limit salt, animal proteins and soft drinks
- Avoiding dietary calcium excess or deficiency
- Abundant hydration (> 2 liters of water per day)
- Medication if necessary (citrates, thiazides, etc.).
📌 Dr Sébastien Dominique also provides this long-term follow-up to reduce the risk of recurrence.
When is an emergency consultation necessary?
You should consult your doctor as soon as possible if you have :
- Intense unilateral back pain
- A total absence of urine
- Fever associated with back pain (risk of serious infection)
- Blood visible in urine
- A history of renal colic or urinary calculi
Do you suffer from urinary stones?
Requirements
My journey
Do you suffer from renal colic?
The practice also handles urological emergencies, in particular renal colic. Don’t wait for pain to set in before consulting us.
📍 Cabinet Urologie Paris Opéra – Paris 17th
📅 Face-to-face consultation or teleconsultation
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