Women who have given birth and have experienced kidney failure, say that kidney failure is definitely more painful. Doctors compare the pain of kidney failure with infarction. It is enough to say that this is one of the most acute pains in the human body and it is medical emergency that requires immediate medical attention.
The pain is throbbing and cramping, cutting, dangerous, starting from hip to distribution along the ureter to the groin. It is often accompanied by nausea and vomiting, which further complicates the treatment because the administration of drugs orally is very difficult and requires intravenous or intramuscular administration of a medication. It is due to the passage of the stone (concretion) in the ureter from the kidney to the bladder.
What caused the kidney failure and why it hurts so much?
Kidney failure is a consequence of the passage of the stone (concretion) in the ureter from the kidney to the bladder. This means people who have crisis had a kidney stone, which for some reason is going to move to the bladder. It is important here to clarify that the kidney stones themselves do not hurt. In the kidneys there are no nerve endings that we could feel the stones, even if they are large. That’s why many people often find out about them only when they receive a kidney failure. If the stone is located near the exit of the kidney, ureter or gets stuck in the entrance of the bladder, urine can no longer drain normally because its path is blocked by a stone. Urine is held above the stone and ureter and kidney inflate – the condition is known as hydronephrosis. Pain in kidney failure is due to “plugging” of the ureter during passage of the concretion through it and hyperextension of the capsule of the kidney due to the retained urine.
In fact, paradoxical as it may sound, most often “hurt” small stones whose dimensions allow them to fall into the ureter because the larger stones (over 6-7 mm) can hardly get into the ureter.
How is it diagnosed?
Usually symptoms of kidney failure are very.
– Pain in the lumbar region extending along the ureter and reaching the testicles or big lips and can last for hours and have seizures alternating with pain, painless period;
– Blood in the urine – rarely seen as red coloring, but in chemical research almost always detected erythrocytes (red blood cells). Prepared in ulceration of the mucous membrane of the urethra of the concretion;
– Painful, burning and frequent urination.
– Temperature – increases mainly in the superimposition of a bacterial infection.
What tests should be done?
When a doctor suspects there is kidney failure it is usually performed:
Ultrasound – often it is the first imaging study because it is quick, painless and informative enough, it can be used in pregnant women, where the X-ray examinations are contraindicated. The ultrasonic waves depict the kidney, giving an idea of the presence of urinary retention. Through this method are detected and urate stones that can not be visualized by X-ray methods.
Radiography – an X-ray image is made covering both kidneys, ureters and bladder. It gives an accurate picture of the amount and size of gallstones and their exact location. Here are the exception urate stones that are “transparent” for X-rays.
Scanner (CT) – used in special cases when the other two methods do not give definite results. Besides portraying concretion it gives a very accurate picture of the state of the kidney. In world practice it is a routine to use a scanner in the diagnosis of renal colic.
Treatment of kidney failure
Treatment of renal colic starting a matter of urgency. It aims to relieve severe pain and to ensure normal drainage of urine from the obstructed kidney. The removal of the stone is not a priority in the treatment of colic, it can be made a few days after the passage of pain. However removal of the cause of the kidney failure, namely the presence of the stone, is the most effective treatment. So whenever available of the equipment, except drug therapy in the treatment of kidney failure may try extra- or intracorporeally breaking stone. The problem is that the condition of urgency is not always possible, and not all hospitals have the necessary equipment and qualified personnel to carry out this activity. In such cases, as we have said, the main goal of treatment of kidney failure as quickly and effectively is to relieve severe pain. This is achieved in two ways – medical and invasive.
1. Medical treatment
Usually patients with kidney failure are extremely exhausted, dehydrated from nausea and vomiting, which make it impossible to take medication orally, the most common treatment starts with the infusion of replacement fluid and saline intravenously. In addition to them in therapy may be included:
Pain Management – one of the main goals of treatment is to reduce pain, which as mentioned is one of the strongest pains in the human body. Usuallydoctors begin with nonsteroidal anti-inflammatory drugs (NSAIDs) in combination with antispasmodics and analgesics. When their action is insufficient, treatment continues with opioid drugs (morphine derivatives).
Antispasmodics – often in combination with NSAID are captured and antispasmodics, which aim to relax the smooth muscle of the urethra, therebylower the spasms and pain and facilitate the elimination of concretion.
Antiemetics – strong pain sometimes leads to collapse, shock and vomiting reflex. Antiemetics relieve nausea and vomiting.
Usually, this treatment is sufficient to concrements measuring about 3-5 mm, for which it is expected that it can pass through the ureter spontaneously or with a little “help”. Larger gallstones require the addition of another type of medications.
Medical expulsive therapy – when there are bigger kidney stones there are used medications, aimed at relaxing the muscles of the urethra. These are alpha-blockers and calcium channel blockers. Since they still operate for a longer period of time, their use is not appropriate as direct treatment of kidney failure. They come as a part of treatment, after resolution of pain attack and provide drainage of urine.
Antidiuretics – used relatively rarely. Their purpose is to reduce the amount of urine for a certain period of time, thereby lower stress on the kidney and thereby – reducing pain. They are used in single doses as a temporary means to take measures for permanent treatment.
Antibioitics – used in case of suspected infection.
2. Invasive treatment
The main goal of treatment of renal colic is the provision of normal drainage of urine. It treats all the symptoms of colic.
Stent type double J (DJ) – consists of placing a thin tube into the urethra, both ends of which are in the form of the letter J. Stent is placed in conditions of anesthesia through the urethra and bladder into the corresponding ureter. This is the least invasive method associated with at least potential complications. Unfortunately, the placement of the stent does not remove the stone. It only unblocks the kidney, which requires additional procedures later (such as extracorporeal lithotripsy).
Intracorporeal lithotripsy – there is an option when there is available equipment before placing the stent when the patient is in anesthesia, to be made an attempt to penetrate into the urethra in order to dismantle the concretion (laser, ultrasound, etc.).
Placing percutaneous nephrostomy – when the stone block the urethra, sometimes stent can not go past it and to provide adequate drainage. Then you may need placement of the tube (nephrostomy) through the skin under ultrasound guidance directly in the kidney. This reduces the pressure and prevent further complications of kidney. It shall be possible to treat gallstones in the planned order.
In most cases (about 70%), treatment of renal colic allows elimination of concrements. When this is not possible, including other methods to treat kidney stones, depending on their size and location.