I have kidney pain, what should I do?

Seek Immediate Medical Evaluation for Kidney Pain

You need to see a healthcare provider urgently—within 30 minutes if the pain is severe—because kidney pain can signal conditions ranging from a passable kidney stone to life-threatening emergencies like infection with obstruction or, in older adults, a leaking aortic aneurysm. 1

Immediate Actions Before Seeing a Provider

Call for Help Now If You Have Any of These Red Flags:

• Fever or chills (suggests infected obstructed kidney—a surgical emergency requiring urgent decompression) 1, 2
• Unable to urinate or only one void in 24 hours (anuria signals complete obstruction) 1
• Persistent vomiting despite trying to control it 1
• Dizziness, rapid pulse, or feeling faint (signs of shock) 1, 2
• Age over 60 years (must rule out leaking abdominal aortic aneurysm, which can mimic kidney pain) 1, 2, 3
• Women of reproductive age with delayed period (must exclude ectopic pregnancy) 2, 3

If any of these apply, call emergency services immediately—do not wait or try home remedies. 1

What to Expect at Your Medical Visit

Initial Assessment (Within 30 Minutes):

Your provider will check your vital signs—pulse, blood pressure, and temperature—to exclude shock or systemic infection. 4, 2 They will examine your abdomen to rule out other serious conditions like peritonitis. 4, 2

Pain Relief:

• First-line treatment is intramuscular diclofenac 75 mg, which provides pain relief within 30 minutes and is superior to opioids for kidney stone pain. 1, 3 The injection route is preferred because oral medications are unreliable when you're in severe pain or vomiting. 1, 3
• If you have allergies to NSAIDs or contraindications (kidney disease, heart disease, history of stomach bleeding), your provider will give you an opioid combined with an anti-nausea medication like morphine plus cyclizine. 1, 3

Critical caveat: If you have known kidney disease, NSAIDs can worsen kidney function, so your provider must use the lowest effective dose or avoid them entirely. 1, 5

When You Need Hospital Admission:

You will be admitted immediately if: 1, 2, 3

• Pain is not controlled within 60 minutes of receiving appropriate pain medication
• You develop fever or signs of infection
• You cannot urinate
• You show signs of shock
• You continue vomiting despite treatment

If You Can Be Managed at Home

Follow-Up Protocol:

• Your provider should call you 1 hour after your initial visit to confirm your pain is controlled. 4, 1
• Pain control must last at least 6 hours before home management is safe. 1, 2
• If severe pain returns abruptly, go to the hospital immediately. 1, 2

Home Care Instructions:

• Drink plenty of fluids (approximately 2 liters per day) 4, 2
• Strain all urine using a fine mesh, tea strainer, or gauze to catch any stone that passes—this allows laboratory analysis to guide prevention strategies 4, 1, 2, 3
• Take a limited supply of oral or rectal NSAIDs (provided by your doctor) for breakthrough pain 4, 1
• About 90% of small kidney stones pass spontaneously, so home management is appropriate for most patients once pain is controlled 1, 2

Required Imaging and Specialist Follow-Up:

• Schedule renal imaging (ultrasound or CT scan) within 7 days to identify the stone and determine if intervention is needed 4, 1, 2, 3
• If a stone is confirmed on imaging, see a urologist within 14 days 4, 1
• For stones larger than 5 mm in the lower ureter, your doctor may prescribe tamsulosin (an alpha-blocker) to help the stone pass—this increases passage rates by approximately 50% 1, 3

Critical Pitfalls to Avoid

• Never delay seeking care while trying home remedies—kidney pain with infection and obstruction can cause permanent kidney damage or death within hours 1
• Do not take NSAIDs if you have kidney disease without medical supervision—they can precipitate acute kidney injury, especially during dehydration or vomiting 1, 5, 6
• If you're over 60, insist that your provider actively excludes aortic aneurysm—this life-threatening condition can present identically to kidney stones 1, 2, 3
• Women: if your period is late, insist on pregnancy testing—ectopic pregnancy can mimic kidney pain and is a surgical emergency 2, 3

Bottom line: Kidney pain is not something to manage on your own. The distinction between a simple kidney stone and a life-threatening emergency can only be made by a medical professional with proper assessment, and this needs to happen urgently. 1, 2