Ureteral obstruction by a stone leads to the production of prostaglandins, which have diuretic effects and so set up a cycle of further ureteral distention and diuresis. Use of prostaglandin synthetase inhibitors is common in the treatment of renal colic but carries the theoretic disadvantage of decreasing renal blood flow when renal function is already compromised. El-Sherif and colleagues investigated the use of desmopressin, a vasopressin analogue with antidiuretic effects, in the treatment of acute renal colic.
Eighteen consecutive patients presenting to the emergency department with acute renal colic were treated initially with 40 [micro]g of intranasal desmopressin. Study subjects did not differ significantly in age, pulse or blood pressure, duration of pain or urine osmolality.
Subjective report of complete pain relief was noted in 44.4 percent of patients after 30 minutes. Subjects who still had pain were treated with 50 mg of intramuscular diclofenac. One patient still had pain after combination therapy and was admitted to the hospital. No side effects were noted in any of the study participants.
The authors conclude that the use of intranasal desmopressin was well tolerated and effective, especially in combination with diclofenac, in the treatment of acute renal colic. Desmopressin has the theoretic benefit of decreasing intraureteral pressure and backflow, which may decrease the risk of renal infection, and also decreases the need for prostaglandin synthetase inhibitors, which impair renal blood flow. (Journal of Urology, May 1995, vol. 153, p. 1395.)
COPYRIGHT 1995 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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