When should I go to the Emergency Room (ER) for a kidney stone?

When to Go to the Emergency Room for a Kidney Stone

You should go to the emergency room immediately for a kidney stone if you experience severe pain that is not controlled with over-the-counter medications, have signs of infection (fever, chills), develop nausea/vomiting preventing fluid intake, or have blood in your urine. 1, 2

Urgent Warning Signs Requiring ER Visit

• Severe, uncontrollable pain: Pain that cannot be managed with over-the-counter medications
• Signs of infection: Fever, chills, or cloudy/foul-smelling urine
• Nausea/vomiting: Especially if preventing adequate fluid intake
• Visible blood in urine: Particularly if heavy or with clots
• Complete inability to urinate: Suggesting complete obstruction
• Signs of shock: Rapid heart rate, dizziness, confusion

Assessment and Management Timeline

Initial Assessment (Within 30 Minutes)

Patients with acute renal colic symptoms should receive medical assessment within 30 minutes 1. If this isn't possible, paramedical services should be called to provide analgesia and transport to the emergency department.

Pain Management

The hallmark of kidney stone pain is an abrupt onset of severe unilateral flank pain radiating into the groin or genitals 1. This pain pattern is highly suggestive of renal colic and warrants immediate attention.

When Home Management Is Appropriate

You may consider home management if:

• Pain is mild to moderate and controlled with over-the-counter pain medications
• No fever or signs of infection are present
• You can maintain adequate fluid intake
• You have a history of passing kidney stones successfully
• The stone is likely small (less than 5mm stones have ~62% spontaneous passage rate) 2

Follow-Up After Initial Assessment

If managing at home, follow up should occur within one hour after initial assessment 1. Drink plenty of fluids and strain your urine to catch any passed stones for analysis.

Special Circumstances Requiring Immediate ER Care

Infection with Obstruction

This is a urological emergency requiring immediate decompression of the collecting system via ureteral stent or percutaneous nephrostomy to prevent sepsis 2, 3. Signs include:

• Fever with flank pain
• Chills or rigors
• Cloudy or foul-smelling urine

Pregnancy

Pregnant patients with kidney stones require special consideration and should seek immediate care if symptomatic, as the condition carries increased risk of maternal and fetal morbidity 1, 2.

Single Kidney

Patients with only one functioning kidney should have a lower threshold for seeking emergency care as complete obstruction could lead to acute kidney injury 2.

Treatment Options in the ER

The ER will typically provide:

1. Pain control (usually with NSAIDs as first-line therapy) 4
2. Imaging (typically ultrasound or low-dose CT scan) 2
3. Intravenous fluids if dehydrated
4. Antibiotics if infection is present
5. Urological consultation if intervention is needed

Follow-Up After ER Visit

After an ER visit for kidney stones, follow-up with a urologist is essential, particularly if:

• The stone did not pass during your ER stay
• You have recurrent stones
• You need metabolic evaluation to prevent future stones 1, 2

Prevention of Future Episodes

To prevent recurrent kidney stones:

• Increase fluid intake to more than 2L/day 2
• Follow dietary modifications based on stone composition
• Complete metabolic testing if you're a high-risk or recurrent stone former 1

Remember that kidney stone disease affects approximately 8.8% of the US population and is increasingly common 4. Proper evaluation and timely intervention can prevent complications and reduce the risk of recurrence.