The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

Kim Davenport,Elizabeth Waine

doi:10.3390/ph3051304

Abstract

NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.

Highlights

Renal colic is a symptom complex characteristic for the presence of a partially or completely obstructing ureteric stone
The likelihood of spontaneous stone passage is related to the site and size of the stone [1], stone passage within six weeks is seen in approximately 50% of all ureteric stones [2] and 98% of stones less than 5 mm diameter
The predominant analgesic action of NSAIDs in renal colic is through inhibition of prostaglandin synthesis

Summary

Introduction

Renal colic is a symptom complex characteristic for the presence of a partially or completely obstructing ureteric stone. The pain is of acute onset, localised to the flank area and may radiate to the groin or genitals. The pain can be perceived in any organ sharing the same innervation as the kidney and ureter at T11-L1. Other associated symptoms include nausea, vomiting and haematuria. The pain associated with renal colic results from a combination of responses to the presence of a stone within the ureter. There is an initial stimulation of ureteric peristalsis in an attempt to move the stone. Oedema and inflammation further narrow the ureter at the level of the stone. Ureteric peristalsis proximal to the stone increases in an attempt to move the stone [4]

NSAIDs and Their Mechanism of Action

The Role of NSAIDs in Providing Analgesia in Renal Colic

The Role of NSAIDs in the Promotion of Stone Passage

Findings

Conclusions