Pathophysiology and symptoms of renal colic in children - a case report.

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.

Urolithiasis in the pediatric population - current opinion on epidemiology, patophysiology, diagnostic evaluation and treatment.

Urolithiasis, a condition in which calculi are found in the urinary tract, has been known for centuries. Although the disease was considered casuistic in the pediatric population, its prevalence is rising among both children and infants. The occurrence of the disease is greater in developed countries, therefore urolithiasis should be considered a lifestyle disease. Its etiopathogenesis has not yet been well understood. Kidney stone formation is influenced by factors such as climate, eating habits, profession, fluid intake, genetic predisposition, urinary tract infections and malformations of the urinary tract. Calculi are usually composed of mixed mineral substances. Only about 30% are made up of one chemical substance, calcium oxalate being the most common. Urolithiasis can be asymptomatic and accidentally diagnosed. Abdominal pain is the most common clinical symptom, however disease presentation among infants is nonspecific. Hematuria is a common clinical finding. Ultrasonography is the most important diagnostic tool in the diagnosis of kidney stone disease. Metabolic evaluation is required in every case of urolithiasis in the pediatric population, as metabolic disorders can be found in the majority of cases in this age group. The spontaneous passage of calculi less than 6mm in diameter is likely. Invasive treatment should be carried out if stones exceed 6mm in diameter or fail to expulse spontaneously. Prophylactic treatment includes adequate fluid intake, healthy eating habits and physical activity to maintain a healthy weight. Urolithiasis is a recurrent disease, therefore long-term treatment, prophylaxis and a lasting change in dietary habits are essential.