

A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient
https://doi.org/10.33667/2078-5631-2024-5-43-47
Abstract
Renal colic is a condition caused by the passage of a concretion from the kidney through the ureter into the bladder, which is accompanied by a pronounced pain syndrome. Patients with renal colic often seek emergency help with complaints of severe pain, nausea, dysuria. However, there is a category of people who, for various reasons, cannot verbally express their feelings. Such patients are called nonverbal. Nonverbal patients are people with severe cognitive impairments or those who are temporarily unable to speak due to surgery or illness, but they can still demonstrate pain using nonverbal signals.In this article, we present an observation of an atypical clinical picture of renal colic in a nonverbal elderly patient. In the observed woman, an acute attack of renal colic lasted 5 days and passed first under the «mask» of acute pancreatitis. Without receiving pathogenetic therapy, the patient developed acute obstructive pyelonephritis, septic shock, which was initially mistaken for an acute violation of cerebral circulation. The performed computed tomography (CT) helped to identify a concretion in the upper third of the ureter on the left, a violation of the outflow of urine from the left kidney. The patient urgently had a stent installed in the pelvis of the left kidney, urine outflow was restored, anti-inflammatory, detoxification, litolytic therapy was prescribed. After that, the patient's condition improved significantly, and after 3 months, a decrease in the size and fragmentation of the concretion was observed during the control CT scan.
Conclusion. Nonverbal patients are a special group of patients whose clinical picture may be blurred or atypical. Assessment of pain symptoms in nonverbal patients is difficult, which can lead to an incorrect diagnosis and lengthen the period of diagnosis of the disease. The timely diagnosis of renal colic in nonverbal patients is also affected by the localization of pain, since its irradiating nature can direct the diagnostic search «on the wrong track».
About the Authors
R. S. FrantsevRussian Federation
Frantsev Roman S. - associate professor at Dept of Urology, Urologist.
Stavropol
T. I. Derevyanko
Russian Federation
Derevyanko Tatyana I. - DM Sci (habil.), professor, head of Dept of Urology and Paediatric Urology-Andrology.
Stavropol
I. V. Pavlenko
Russian Federation
Pavlenko Igor V. - PhD Med, urologist, head of Urology Dept.
Stavropol
O. G. Hadzhiev
Russian Federation
Khadzhiev Odisey G. - urologist, Urological Dept No.1.
Stavropol
A. V. Osipov
Russian Federation
Osipov Arsen V. - urologist.
Stavropol
N. V. Karaseva
Russian Federation
Karaseva Natalya V. - senior lecturer at Dept of Biology and General Genetics.
Moscow
O. O. Krupina
Russian Federation
Krupina Olga O. - 2nd year student at General Medicine Faculty of Medical Institute.
Moscow
D. M. Tkachenko
Russian Federation
Tkachenko Daniil M. - 6th year student at General Medicine Faculty.
Moscow
References
1. Alfahhad MF, Qasem HA, Alrajhi NN, Khayat LT, Alsulami MK, Al Marri SA, Alshuqaybi HM, Aldhafyan SR, Al Jabir FM, Albaqami NA, Alyami AM, Alamrani AM, Abusabir DN, Alkhaldi AN, Al-Hawaj F. Ruptured Isolated Common Iliac Artery Aneurysm Masquerading as Renal Colic. Cureus. 2021 Nov 19;13(11): e19752. doi: 10.7759/cureus.19752.
2. Barnett D, Kinnear N, Yao HH, Chee J. Renal colic causing Boerhaave syndrome. Transl Androl Urol. 2020 Apr;9(2):828–830. doi: 10.21037/tau.2019.12.11.
3. Ganti S, Sohil P. Renal Colic: A Red Herring for Mucocele of the Appendiceal Stump. Case Rep Emerg Med. 2018 Dec 6;2018:2502183. doi: 10.1155/2018/2502183
4. Imamoglu M, Aygun A, Bekar O, Erdem E, Cicek M, Tatli O, Karaca Y, Sahin A, Turkmen S, Turedi S. A retrospective analysis of nebulized versus intravenous fentanyl for renal colic. Am J Emerg Med. 2017 May;35(5):757–763. doi: 10.1016/j.ajem.2017.01.026.
5. Kilic Y, Gokdogan Y, Abdullah S. Spontaneous renal pelvis haematoma presenting as renal colic. BJR Case Rep. 2018 Oct 2;5(1):20180086. doi: 10.1259/bjrcr.20180086.
6. Mann U, Jain K, Wong R, Li Z, Eng A, Blachman-Braun R, Patel P. Predictors of mortality for patients admitted to the intensive care unit with obstructing septic stones. Can Urol Assoc J. 2021 Nov;15(11): E 593-E 597. doi: 10.5489/cuaj.7118.
7. Reyner K, Heffner AC, Karvetski CH. Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection. Am J Emerg Med. 2016 Apr;34(4):694–6. doi: 10.1016/j.ajem.2015.12.068.
8. Schoenfeld EM, Pekow PS, Shieh MS, Scales CD Jr, Lagu T, Lindenauer PK. The Diagnosis and Management of Patients with Renal Colic across a Sample of US Hospitals: High CT Utilization Despite Low Rates of Admission and Inpatient Urologic Intervention. PLoS One. 2017 Jan 3;12(1): e0169160. doi: 10.1371/journal.pone.0169160.
9. Schoenfeld EM, Shieh MS, Pekow PS, Scales CD, Jr, Munger JM, Lindenauer PK. Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic. JAMA Netw Open. 2019;2: e1916454.
10. Thia I, Saluja M. An update on management of renal colic. Aust J Gen Pract. 2021 Jul;50(7):445–449. doi: 10.31128/AJGP-11–20–5751.
11. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol. 2016 Mar;69(3):468–74. doi: 10.1016/j.eururo.2015.07.040
12. Gromov A. I., Builov V. M. Radiation diagnostics and therapy in urology. М.: GEOTAR-Media; 2011 (in Russ.)
13. Kaprin A. D., Apolikhin O. I., Sivkov A. V., Anokhin N. V., Gadzhiev N. K., Malkhasyan V. A., Akopyan G. N., Prosyannikov M. Y. Incidence of urolithiasis in the Russian Federation from 2005 to 2020. Experimental and Clinical Urology 2022;15(2)10–17. https://doi.org/10.29188/2222–8543–2022–15–2–10–17
14. Kulchenko N. G., Vekilyan M. A. Analysis of antibiotic sensitivity of e. coli in patients with chronic calculous pyelonephritis. RUDN Journal of Medicine. 2016;3:125–131. (In Russ.)
15. Kulchenko NG, Vekilian MA. Data of change of microflora antibacterial sensitivity to antibiotics in patients with chronic calculous pyelonephritis and diabetes mellitus of type 2. Bulletin of the Medical Institute “REAVIZ” (Rehabilitation, Doctor and Health). 2016;3(23):85–90. (In Russ.)
16. Petrov VI, Vinarov AZ, Vekilyan MA, Kulchenko NG. Changes in the structure of pathogens of calculous pyelonephritis complicated with diabetes mellitus type ii, in the hospital urology of the city of Volgograd. Urologiia. 2016;4:58–62. (In Russ.)
Review
For citations:
Frantsev R.S., Derevyanko T.I., Pavlenko I.V., Hadzhiev O.G., Osipov A.V., Karaseva N.V., Krupina O.O., Tkachenko D.M. A clinical case of an atypical clinical pattern of renal colic in a nonverbal patient. Medical alphabet. 2024;(5):43-47. (In Russ.) https://doi.org/10.33667/2078-5631-2024-5-43-47