Kidney Stone Symptoms
The most common symptoms of kidney stones include flank pain (renal colic), hematuria, dysuria, urinary frequency, fever, and groin pain. 1, 2
Primary Symptoms
Flank Pain (Renal Colic):
- Caused by ureteral hyperperistalsis when a stone is present
- Often severe, sharp, and colicky in nature
- May radiate from the flank to the groin or genital area
- Can fluctuate in intensity as the stone moves
Hematuria:
- Blood in the urine (may be visible or microscopic)
- Results from irritation and trauma to the ureter by the stone
Urinary Symptoms:
- Dysuria (painful urination)
- Urinary frequency
- Urgency to urinate
Secondary Symptoms and Complications
Hydronephrosis:
- Swelling of the kidney due to ureteral obstruction
- Can be detected on imaging studies
- Moderate to severe hydronephrosis is highly specific (94.4%) for symptomatic renal stones 1
Infection Signs:
- Fever
- Chills
- Pyuria (pus in urine)
- These symptoms may indicate a urinary tract infection complicating the stone
Nausea and Vomiting:
- Often accompanies severe renal colic
- May be due to shared autonomic innervation between kidneys and GI tract
Symptom Variations by Stone Location
Kidney Stones:
- Dull, aching pain in the flank or back
- May be intermittent or persistent
Ureteral Stones:
- Sharp, severe, colicky pain
- Pain may radiate to the lower abdomen and groin
- Larger and more proximally located stones are associated with lower rates of spontaneous passage 1
Bladder Stones:
- Suprapubic pain
- Pain at the end of urination
- Interrupted urinary stream
Asymptomatic Stones
- Some kidney stones may be asymptomatic and discovered incidentally on imaging
- Even asymptomatic stones may require monitoring as they can grow or become symptomatic over time
Risk Factors and Associated Conditions
Kidney stones are associated with several conditions that may influence symptoms:
- Obesity
- Metabolic syndrome
- Diabetes
- Hypertension
- Family history of stones
- Previous stone episodes
- Certain medications
- Anatomical abnormalities of the urinary tract 2, 3
When to Seek Immediate Medical Attention
Patients should seek immediate medical care if experiencing:
- Severe pain unrelieved by over-the-counter pain medications
- Pain with fever and chills
- Nausea and vomiting preventing medication or fluid intake
- Inability to urinate
- Blood in the urine
Diagnostic Approach
When kidney stone symptoms are present, diagnostic evaluation typically includes:
- Urinalysis (both dipstick and microscopic evaluation) to assess urine pH, indicators of infection, and identify crystals 1
- Urine culture if infection is suspected 1
- Imaging studies, with renal ultrasonography recommended as first-line imaging modality 2
- CT scan without contrast is considered the reference standard for urolithiasis diagnosis, with sensitivity as high as 97% 1
The combination of clinical symptoms, laboratory findings, and imaging studies helps confirm the diagnosis of kidney stones and guides appropriate management.