Will a stone in the left lower pole of the kidney cause pain?

Pain from a Stone in the Left Lower Pole of the Kidney

Yes, a stone in the left lower pole of the kidney can cause pain, even without causing obstruction. While kidney stone pain is classically associated with obstruction of the urinary tract, non-obstructing stones located in the lower pole can still cause significant pain and impact quality of life.

Mechanism of Pain in Kidney Stones

• Kidney stone pain typically presents as colicky in nature, with waves of severe pain followed by periods of less intense discomfort 1
• The primary mechanism of pain is internal pressure from obstruction rather than external compression 1
• Stones in the kidney, including the lower pole, can cause pain through several mechanisms:
  • Direct irritation of the renal collecting system 2
  • Intermittent partial obstruction causing distension 1
  • Inflammation of surrounding tissues 2

Clinical Evidence of Pain from Lower Pole Stones

• A 2024 multicenter observational trial demonstrated that patients with non-obstructing calyceal stones (including lower pole stones) experienced significant pain relief after stone removal 3
  • Preoperative pain scores averaged 5.5 (mean) and 7.2 (worst) on the Brief Pain Inventory
  • After removal of non-obstructing stones, pain scores decreased to 1.8 (mean) and 2.8 (worst) at 12 weeks
  • 86% of patients had at least a 20% reduction in mean pain scores after stone removal 3

Diagnostic Considerations

• Non-contrast CT is the gold standard for diagnosing kidney stones, with sensitivity as high as 97% 1
• Ultrasound combined with radiography can be an alternative with sensitivity of 79-90% 1
• The addition of color Doppler with assessment of twinkling artifact improves sensitivity for small renal stones 1
• When evaluating lower pole stones, it's important to assess:
  • Stone size (larger stones more likely to cause symptoms) 2
  • Presence of hydronephrosis (indicating obstruction) 2
  • Stone composition (some types may cause more irritation) 2

Differentiating Features of Stone Pain

• Kidney stone pain is not typically worsened by external pressure on the flank area 1
• Pain that significantly worsens with external pressure suggests other conditions like pyelonephritis or perinephric abscess 1
• Common symptoms associated with kidney stones include:
  • Renal colic (severe, intermittent pain) 4
  • Hematuria (blood in urine) 4
  • Dysuria and urinary frequency 4
  • Groin pain that may radiate 4

Clinical Implications

• Lower pole stones, even when non-obstructing, should be considered as a potential source of pain in patients with flank discomfort 3
• Surgical removal of symptomatic non-obstructing lower pole stones can significantly improve quality of life 3
• Treatment decisions should consider stone size, location, and patient symptoms 2
• Stone size and location are important determinants in spontaneous passage rates and need for intervention 2

Potential Pitfalls

• Not all flank pain with hematuria is due to kidney stones - consider other diagnoses such as Page kidney, tumor, or vascular malformations 5
• Lower pole stones may be missed on standard imaging if not specifically evaluated 2
• Anatomical variations like duplex collecting systems can complicate diagnosis and management of kidney stones 6
• Asymptomatic kidney stones are common and may be incidental findings unrelated to the patient's pain 7