Kidney Stone Symptoms
Kidney stones typically present with severe loin pain (renal colic), accompanied by frequent urination, dysuria, oliguria, and hematuria. 1
Classic Symptom Presentation
The hallmark symptom complex includes:
- Severe flank/loin pain that can radiate to the groin, caused by ureteral irritation and trauma as stones move through the ureter 2, 1
- Hematuria (blood in urine), which occurs in the majority of symptomatic cases 1
- Urinary symptoms including dysuria (painful urination), urinary frequency, and oliguria (reduced urine output) 1
- Fever may develop, particularly if infection is present 3
Important Clinical Distinctions
Nonobstructing lower pole stones, particularly those <5 mm, are often completely asymptomatic and discovered incidentally. 2 This is a critical point: small, stationary stones rarely cause spontaneous bleeding or symptoms unless they begin to move 2.
Precipitating Factors
Acute renal colic can be triggered by:
- Dehydration and reduced urine output 1
- Increased protein intake 1
- Heavy physical exercise 1
- Certain medications (protease inhibitors, antibiotics, some diuretics) 4
Common Pitfall to Avoid
Do not attribute hematuria to tiny nonobstructing stones without considering other sources, particularly in older males where prostatic and bladder pathology are common. 2 Mild hematuria after stone manipulation procedures occurs in approximately 50% of cases, but spontaneous bleeding from small, stationary stones is uncommon 2.
When Symptoms Warrant Intervention
Stones smaller than 5 mm normally pass spontaneously within 17 days (range 6-29 days), with passage rates of 75%. 5, 1 Spontaneous passage rates vary by location: 68-83% for distal ureteral stones, 58-70% for mid-ureteral stones, and 49-52% for upper ureteral stones 5.
For stones >5 mm in the distal ureter, medical expulsive therapy (α-blockers) provides the greatest benefit. 5, 3
Emergency Symptoms Requiring Urgent Intervention
In cases of sepsis and/or anuria in an obstructed kidney, urgent decompression via percutaneous nephrostomy or ureteral stenting is mandatory. 5 Warning signs include: