From the Guidelines
NSAIDs can be used for renal colic pain, with intramuscular diclofenac 75 mg recommended as first-line treatment when the diagnosis is clear and there are no signs of complications. According to the study published in the BMJ in 2002 1, this approach is based on evidence and consensus for managing acute renal colic across the primary-secondary care interface. The use of NSAIDs in this context is supported by their mechanism of action, which involves inhibiting prostaglandin synthesis to reduce inflammation and pain, as well as decreasing ureteral pressure and diuresis that can worsen pain.
Key considerations for the use of NSAIDs in renal colic pain include:
- Diclofenac (50-100 mg orally or 75 mg intramuscularly) is a commonly used option
- Ketorolac (30 mg IV or 10 mg orally) and ibuprofen (400-800 mg orally every 6-8 hours) are alternative options
- Short-term use (typically 3-5 days) is recommended to minimize side effects
- Patients with kidney disease, heart failure, or gastrointestinal issues should use NSAIDs with caution, as they can cause volume-dependent renal failure, interstitial nephritis, and nephritic syndrome, especially in those with preexisting renal disease, congestive heart failure, or cirrhosis 1
Adequate hydration should be maintained during treatment, but excessive fluid intake is not recommended as it may increase ureteral pressure. If pain persists beyond 24-48 hours despite medication, medical reevaluation is necessary as this could indicate complications requiring urological intervention.
From the FDA Drug Label
Renal EffectsLong-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion In these patients, administration of a NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation.
NSAIDs and Renal Colic Pain:
- NSAIDs can be used for renal colic pain, but with caution in patients with impaired renal function or a history of kidney disease.
- The use of NSAIDs, such as ketorolac tromethamine, may precipitate overt renal decompensation in patients with compromised renal function.
- Key Considerations:
- Patients with impaired renal function or a history of kidney disease should be closely monitored.
- The lowest effective dose should be used for the shortest possible duration.
- Alternate therapies that do not involve NSAIDs should be considered for high-risk patients 2.
From the Research
NSAIDs for Renal Colic Pain
- NSAIDs can be used for renal colic pain, as they have been shown to be effective in relieving acute renal colic 3, 4, 5, 6, 7
- Studies have compared the efficacy of NSAIDs with opioids and paracetamol in the treatment of acute renal colic, with results indicating that NSAIDs are equivalent to opioids or paracetamol in relieving pain at 30 minutes 7
- NSAIDs have been found to require fewer rescue treatments and have lower vomiting rates compared to opioids 4, 7
- The addition of antispasmodics to NSAIDs does not result in better pain control 6
Efficacy of Different NSAIDs
- Different NSAIDs have been studied for their efficacy in treating renal colic, including ketorolac, diclofenac, and indomethacin 3, 4, 5, 6
- Ketorolac has been found to be as effective as titrated IV meperidine for the relief of acute renal colic, with fewer adverse effects 3
- A noninferiority randomized controlled trial found that intravenous ketorolac at doses of 10,20, and 30 mg can produce similar analgesic efficacy in renal colic 5
Safety and Adverse Effects
- NSAIDs have been found to have a lower risk of adverse effects compared to opioids, including fewer cases of vomiting 4, 7
- However, NSAIDs can expose patients to a risk of functional renal impairment, especially in patients with heart failure, renal artery stenosis, dehydration, renal impairment, or ongoing treatment with a nephrotoxic drug, and the very elderly 4
- Major adverse effects are not reported in the literature for the use of NSAIDs for treatment of renal colic 6