Can kidney stones cause visible blood in urine and how are they managed?

From the Guidelines

Yes, kidney stones can cause macroscopic hematuria, which is visible blood in the urine, often appearing bright red or cola-colored. This condition occurs when stones damage the urinary tract lining as they move, causing bleeding 1. Kidney stones are managed through a combination of pain control, hydration, and stone removal techniques depending on size and location.

Management of Kidney Stones

For pain management, medications like ibuprofen (600-800mg every 6-8 hours) or stronger prescription pain relievers such as ketorolac or narcotics may be needed. Patients should increase fluid intake to 2-3 liters daily to help flush out smaller stones.

• Alpha-blockers like tamsulosin (0.4mg daily) may be prescribed to relax ureter muscles and facilitate stone passage.
• Small stones (less than 5mm) often pass naturally within 1-2 weeks, while larger stones may require medical intervention such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy.

Prevention Strategies

Prevention strategies include maintaining hydration, limiting sodium and animal protein intake, and sometimes medications like thiazide diuretics, potassium citrate, or allopurinol depending on stone composition 1. Patients should seek immediate medical attention if experiencing severe pain, fever, chills, or inability to urinate, as these may indicate complications like infection or complete blockage.

Key Considerations

• The management and prevention of kidney stones should be tailored to the individual patient based on stone type, size, location, and the patient's overall health status.
• Increasing fluid intake to achieve at least 2 L of urine per day is recommended to prevent recurrent nephrolithiasis 1.
• Pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended for patients with active disease in which increased fluid intake fails to reduce the formation of stones 1.

From the Research

Causes of Macroscopic Haematuria

• Kidney stones are a common cause of macroscopic haematuria, which is visible blood in the urine 2, 3, 4
• Other causes of macroscopic haematuria include urinary tract infections, ureteric and renal stones, trauma, tumors, vascular, and miscellaneous causes 3, 5, 4

Diagnosis and Management

• The diagnosis of macroscopic haematuria involves a range of investigations, including computed tomography intravenous pyelogram, urine cytology, urine microscopy and culture, and blood tests 2, 3, 6
• Patients with risk factors for genitourinary malignancy, macroscopic haematuria, or those in whom no cause is found, should be referred to a urological service for further investigation, including cystoscopy 2, 4
• CT urography is a useful diagnostic tool for evaluating macroscopic haematuria, and can be used to detect urinary tract calculi, renal parenchymal diseases, and urothelial diseases 3, 6

Investigation and Referral

• Patients with visible haematuria require urgent, stringent investigation, and should be referred to a specialist for further assessment and investigation 2, 4
• One-stop clinics have been shown to improve the patient experience in early diagnosis of potentially life-threatening conditions, such as bladder cancer 4