Author/Editor		Hajdinjak, Tine
Title		Ledvične kolike
Translated title		Renal colic
Type		članek
Source		Med Mes
Vol. and No.		Letnik 2, št. 12
Publication year		2006
Volume		str. 384-9
Language		slo
Abstract		Renal colic is strong, one-sided pain, which is caused by blockage of ureteral flow of urine. Pain is often reflected and radiates towards testis or labia. Is can be accompanied with sickness, nausea, most often there is also microhematuria. Other conditions, which need urgent treatment, should be excluded (aortic aneurysm, ectopic pregnancy, inflammations...). Non-contrast CT is investigation of choice for suspected renal colic, however, as it is not available in our situation, we use ultrasound and execretory urography instead. Treatment includes analgetics (diclofenac in case of normal renal function) and spasmolytic drugs for relaxation of ureter. Today antiholinergics have fallen out of favour for this purpose. Alpha adrenergic blocking agents (tamsulosin, doxazosine) are drugs of choice. They reduce pain, frequency of colic attacks and shorten time to spontaneous stone expulsion. Indications for urgent hospital referral are inability to suppress pain with peroral analgesisc after first parenteral dose, emesis, which needs parenteral rehydration, septic conditions or renal failure, which require urgent urine drainage, pregnancy, patients with single kidney... Most stones, smaller than 4 mm, will be execreted spontaneously. For persisting stones, urological intervention is indicated.
Summary		Ledvična kolika je močna enostranska bolečina, ki nastane zaradi oviranega odtekanja urina po ureterju. Bolečina je pogosto prenesena, seva navzdol proti spolovilom. Spremlja jo lahko slabost, bruhanje, najpogosteje je pridružena mikrohematurija. Potrebno je izključiti druga urgentna stanja, kot so anevrizma aorte, ektopična nosečnost, vnetja... Diagnostična metoda izbora je CT brez kontrasta z ustreznim protokolom za manjši odmerek sevanja. Ker ta pri nas žal ni na razpolago, si pomagamo s pregledno sliko urotrakta in ultrazvokom (slaba občutljivost) ter iv urografijo, ki bolnika obremeni z nefrotoksičnim kontrastnim sredstvom. Zdravljenje vključuje analgetik (diklofenak, v kolikor ni prizadeta ledvična funkcija) in spazmolitik za ureter. Dandanes ne izberemo antiholinergika, temveč alfa blokator (tamsulozin, doksazosin). Ta prispeva k olajšanju bolečine in omogoči hitrejše spontano izločenje konkrementa. Indikacija za nujno napotitev v bolnišnico je nezmožnost olajšanja bolečine s peroralnimi analgetiki po začetnem parenteralnem odmerku, huda slabost, ki zahteva rehidracijo, septično stanje ali ledvična odpoved, ki zahtevata urgentno drenažo, nosečnost, bolniki z eno ledvico. Večina konkrementov, manjših od 4 mm, se izloči sama. Pri konkrementih, ki se ne izločijo sami, je potreben urološki poseg.
Descriptors		KIDNEY CALCULI ANALGESICS PARASYMPATHOLYTICS