Patti Laryssa, Leslie Stephen W.
Rutgers Rutgers Robert Wood Johnson Medical School
Creighton University School of Medicine
Acute renal colic is a severe and sudden flank pain that typically originates at the costovertebral angle and extends anteriorly and inferiorly toward the groin or testicle. This condition is usually caused by an acute urinary tract obstruction due to calculus and is often associated with nausea and vomiting. Urolithiasis, commonly known as kidney stones, is a prevalent condition affecting approximately 1 in 11 individuals in the United States at some point in their lives. Urolithiasis typically occurs when a crystal or crystalline aggregate travels from the kidney through the genitourinary system, becoming lodged and obstructing urinary flow, usually in the ureter. This obstruction leads to proximal ureteral and renal pelvic dilation (hydroureteronephrosis), which is the primary cause of the intense pain known as renal colic. The intensity of pain is related to the degree of obstruction, rather than the size of the stone, although stone size can help predict the likelihood of spontaneous passage. Although kidney stones are not the only cause of flank pain, their prevalence and the severity of the pain they cause make ureterolithiasis the most likely presumptive diagnosis when sudden, severe flank pain occurs, particularly when associated with hematuria. The nature, onset, location, and severity of the pain vary depending on the underlying cause. However, for most patients, the pain typically peaks 1 to 2 hours after its initial onset. Underlying causes of urolithiasis include inadequate hydration, aciduria, chronic urinary infections, hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia. The initial evaluation of a patient presenting with acute renal colic involves laboratory testing, urinalysis, and appropriate imaging studies. The immediate treatment of acute renal colic due to urolithiasis includes pain control, intravenous (IV) hydration, antiemetics, and antibiotics (if indicated). Patients with severe or refractory symptoms may require hospital observation or admission. In some cases, urgent surgical intervention is necessary, such as in obstructive pyelonephritis (pyonephrosis), where emergent drainage of the infected renal pelvis is required. Definitive treatment for obstructing ureteral stones may involve conservative or procedural approaches. Surgical options include cystoscopy with double J stenting, extracorporeal shockwave lithotripsy (ESWL), ureteroscopy with stone basketing, and laser therapy, as open surgery for ureteral stones is rarely necessary. Please see StatPearls' companion resource, "Ureterolithiasis," for more information. Quality of life scores typically decrease as the frequency of kidney stone attacks increases. This decline is most noticeable when a patient experiences 5 or more lifetime episodes of renal colic, indicating that preventive measures, such as 24-hour urine testing, should be considered at that point, if not earlier.
急性肾绞痛是一种严重且突发的胁腹疼痛，通常起始于肋脊角，向前下方延伸至腹股沟或睾丸。这种情况通常由结石导致的急性尿路梗阻引起，常伴有恶心和呕吐。尿石症，俗称肾结石，是一种常见病症，在美国约每11人中就有1人在人生的某个阶段会受到影响。尿石症通常发生在晶体或晶体聚集体从肾脏经生殖泌尿系统移动时，通常会在输尿管中滞留并阻塞尿液流动。这种梗阻会导致输尿管近端和肾盂扩张（肾盂积水），这是导致肾绞痛剧痛的主要原因。疼痛强度与梗阻程度有关，而非结石大小，尽管结石大小有助于预测自然排出的可能性。虽然肾结石并非胁腹疼痛的唯一原因，但它们的患病率以及所引起疼痛的严重性，使得输尿管结石症成为突发严重胁腹疼痛时最可能的初步诊断，尤其是伴有血尿时。疼痛的性质、发作、位置和严重程度因潜在病因而异。然而，对大多数患者来说，疼痛通常在最初发作后1至2小时达到峰值。尿石症的潜在病因包括水分摄入不足、酸性尿、慢性尿路感染、高钙尿症、高草酸尿症、高尿酸尿症和低枸橼酸尿症。对出现急性肾绞痛的患者进行的初步评估包括实验室检查、尿液分析和适当的影像学检查。因尿石症导致的急性肾绞痛的即刻治疗包括控制疼痛、静脉补液、使用止吐药和抗生素（如指征明确）。症状严重或难治的患者可能需要住院观察或收治入院。在某些情况下，如梗阻性肾盂肾炎（脓肾），需要紧急引流感染的肾盂，此时需要进行紧急手术干预。对阻塞性输尿管结石的确定性治疗可能涉及保守或手术方法。手术选择包括膀胱镜下双J管置入术、体外冲击波碎石术（ESWL）、输尿管镜下取石术和激光治疗，因为输尿管结石很少需要进行开放手术。更多信息请参阅StatPearls的配套资源“输尿管结石症”。随着肾结石发作频率的增加，生活质量评分通常会下降。当患者一生中经历5次或更多次肾绞痛发作时，这种下降最为明显，这表明在此时（如果不是更早的话）应考虑采取预防措施，如24小时尿液检测。
