Symptoms of Kidney Stones
The most common symptoms of kidney stones include acute flank pain, hematuria, dysuria, urinary frequency, and in some cases fever, with the severity of symptoms often correlating with the size and location of the stone. 1
Primary Symptoms
- Renal colic: Severe, sudden-onset pain typically located in the flank (side) that may radiate to the lower abdomen and groin. This is caused by ureteral hyperperistalsis as the stone moves through the urinary tract 1
- Hematuria: Blood in the urine resulting from irritation and trauma to the ureter by the stone 1
- Urinary symptoms: Including frequent urination and dysuria (painful urination) 2
- Nausea and vomiting: Often accompany the severe pain of renal colic 3
Symptom Variations by Stone Location
- Kidney stones: May cause dull, aching flank pain or be asymptomatic if not causing obstruction 1
- Upper ureteral stones: Severe flank pain that may radiate to the upper abdomen 1
- Mid-ureteral stones: Pain that may radiate anteriorly and toward the groin 1
- Distal ureteral stones: Pain that commonly radiates to the groin, testicle in men, or labia in women 1
Complications and Associated Symptoms
- Hydronephrosis: Swelling of the kidney due to ureteral obstruction, which can worsen pain and potentially lead to kidney damage 1
- Urinary tract infection: Presenting with fever, chills, cloudy or foul-smelling urine 1
- Sepsis: A life-threatening complication of obstructed infected stones, presenting with high fever, hypotension, and altered mental status 1
- Oliguria: Reduced urine output in cases of significant obstruction 4
Symptom Severity Based on Stone Characteristics
- Stone size: Stones <5 mm typically cause milder symptoms and have a 75% chance of spontaneous passage, while stones ≥5 mm cause more severe symptoms and have a 62% passage rate 1
- Stone location: Passage rates vary by location: 49-52% for upper ureteral stones, 58-70% for mid-ureteral stones, and 68-83% for distal ureteral stones 1
- Stone composition: Different types of stones (calcium oxalate, uric acid, cystine) may present with varying symptom patterns 1, 5
Special Considerations
- Asymptomatic stones: Some kidney stones, particularly those that remain in the kidney and don't cause obstruction, may be completely asymptomatic and discovered incidentally on imaging 1
- Atypical presentations: Elderly patients and those with diabetes may have blunted pain responses and present with vague symptoms 2
- Pregnancy: Renal colic is the most common non-obstetric cause of abdominal pain requiring hospitalization during pregnancy 1
Red Flags Requiring Immediate Medical Attention
- Fever with flank pain: Suggests possible infection with obstruction (obstructive pyelonephritis), a urological emergency 1
- Anuria: Complete cessation of urine output suggesting bilateral obstruction or obstruction of a solitary kidney 1
- Intractable pain or vomiting: May indicate a complicated stone requiring urgent intervention 2
- Signs of sepsis: Including high fever, hypotension, tachycardia, or altered mental status 1