Symptoms of Kidney Stones

While it can be very painful in the short-term to pass kidney stones, the good news is that doing so usually does not cause any permanent damage. In some cases, simply increasing the amount of water that you drink can help you pass a stone. Other cases may require surgery. Your doctor can help you determine proper treatment methods for your condition, and may suggest preventive measures you can take to help avoid developing more in the future.

Kidney stones are among the most common urinary tract disorders. Kidney stones can form in your kidneys when normal substances in your urine become too concentrated. When this happens, solid material can stay in your kidney or may move down your urinary tract, eventually passing out of your body. Read through this article to determine if symptoms you’re experiencing might be related to kidney stones.

What Causes Symptoms?

Kidney stones don’t always produce symptoms. When they’re small, they may pass on their own without pain. However, large stones may block urine flow, which can cause a number of painful symptoms that can be quite severe. This can happen when a kidney stone becomes stuck in the tube that connects your bladder and your kidneys, which is called the ureter. However, the size of the stone doesn’t always correspond to the severity of pain.

Short or Long, On and Off

You may experience constant pain, or the pain may come and go in waves, sometimes lasting for a few minutes and then disappearing, only to resurface again about 10 minutes later. In some cases, the pain may last for a longer time while fluctuating in intensity. A change in the level of intensity may occur as the stone moves to a different position in your urinary tract.

Accompanying Symptoms

In addition to feeling severe pain in your back and/or side below your ribs, a number of other signs and symptoms may also occur with kidney stones. One of the most common is problems with urination. This includes pain while urinating, urine that appears cloudy or smells differently than it normally does, or feeling an urge to urinate more often than usual. Blood present in the urine due to kidney stones can also cause urine to appear brown, pink, or red.

Other Signs

Some people with kidney stones may also experience nausea and vomiting—as well as chills or fever if an infection has occurred. You should see a doctor if pain accompanies nausea, vomiting, chills, or fever. Other reasons to seek medical help include:

pain that becomes so severe you can’t sit, stand, or lie down comfortably
blood in your urine
having a hard time urinating

Clock Clues

If you’re uncertain whether your symptoms might be related to kidney stones, the clock may provide you with clues. Pain from kidney stones usually starts either late or early in the morning. This is because people generally urinate less frequently at night or in the early morning, and the ureter is usually constricted in the morning.

Confirming Your Symptoms

Your doctor can help confirm the presence of kidney stones by administering diagnostic tests. Depending on your specific symptoms, your doctor may suggest a blood or urine test. You may have kidney stones if your blood contains too much calcium or uric acid, or if you’re excreting certain substances in your urine. An imaging test can actually show whether you have kidney stones in your urinary tract.

What to Watch For

The location of the stone and its progress through your urinary tract can affect the type of symptoms you experience. Many people describe the feeling of kidney stones as a sharp pain on one side of the back or lower abdomen. The pain often starts abruptly and then lingers, becoming more intense over time. The affected area can also spread to include the groin area and lower abdomen.

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kidney Stone Prevention and Treatment Programs

Kidney stone specialist David S. Goldfarb, MD, clinical chief of nephrology at New York University Langone Medical Center in New York, pointed out the ACP's guidelines suggest that evidence for the efficacy of increasing fluid intake is weak and leave an impression that increasing fluid intake is not an important prescription for patients with kidney stones. “We know that it is an extremely important prescription, not just because it's efficacious, but because it's inexpensive and because it's safe,” Dr. Goldfarb said.

Randomized controlled trials have already provided convincing evidence of the safety and efficacy of increasing fluid intake, he said. Adding in what is understood about urine chemistry, “we know that increasing fluid intake leads to a reduction in supersaturation.”

The notion that more studies are needed to confirm that increasing fluid intake can prevent kidney stones is incorrect, said Dr. Goldfarb, who is president of the ROCK [Research on Calculus Kinetics] Society and director of kidney stone prevention and treatment programs at New York Harbor VA Healthcare System.

The new study provides “additional confirmatory evidence” of the safety and efficacy of high fluid intake for preventing kidney stones, he told Renal & Urology News.

Dr. Goldfarb's usual fluid prescription for kidney stone prevention is 96 ounces per day, assuming the weather is not very hot and the patient is not exercising too much or experiencing increased bowel losses of water. He typically instructs patients to think of 96 ounces in terms of 8 × 12 (8 12-ounce or 12 8-ounce portions). “You need a way to visualize this. “It's not enough to say to people, ‘drink a lot,' you have to say what a lot means.”

The other study by Dr. Lieske and colleagues, which was presented by Majuran Perinpam, BSc, included 416 female and 293 male subjects (mean age 64.6 and 66.5 years, respectively). Results showed that urinary calcium declined with age, and levels were higher in males than females. An increase in serum creatinine caused urine calcium to decrease. Urinary oxalate excretion was greater in males despite no difference in oxalate intake, “suggesting sex differences in metabolism or other food intake,” Dr. Lieske and his collaborators wrote in a poster presentation. Urinary uric acid excretion correlated positively with body mass index and estimated glomerular filtration rate (as calculated using cystatin C). Cystatin C correlations with uric acid may relate to hyperuricemia and inflammation, according to the researchers

Kidney Stones Often Prompt Second ER Visit

The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together. People with certain medical conditions, such as gout, and those who take certain medications or supplements are at risk for kidney stones. According to a study published online in Academic Emergency Medicine.

Charles D. Scales Jr., M.D., from the Duke University School of Medicine in Durham, N.C., and colleagues analyzed data from all patients in California initially treated and released from emergency departments for kidney stones from February 2008 through November 2009. The authors sought to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of repeat emergency department visits.

The researchers found that among 128,564 patients discharged from emergency care, 11% had at least 1 additional emergency visit for treatment of their kidney stone, with nearly 1 in 3 of these patients requiring hospitalization or an urgent temporizing procedure at the second visit.

On multivariable analysis, the risk of an emergency revisit was associated with insurance status (e.g., Medicaid versus private insurance; odds ratio [OR], 1.52). Greater access to urologic care was associated with lower odds of an emergency revisit (highest versus lowest quartile OR, 0.88). Performance of a complete blood count was also associated with decreased odds of revisit (OR, 0.86).

"Efforts are indicated to identify preventable causes of emergency department revisits for kidney stone patients and design interventions to reduce the risk of high-cost, high-acuity, repeat care," the authors write.

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High Fluid Intake Lowers Kidney Stone Risk

kidney stone, also known as a renal calculus or nephrolith, is a calculus formed in the kidneys from minerals in the urine. Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Most kidney stones will pass through the ureter to the bladder on their own with time. If needed, lithotripsy or surgical techniques may be used for stones which do not pass through the ureter to the bladder on their own.

In a meta-analysis, researchers found that high fluid intake is effective and appears to be safe for the prevention of incident and recurrent kidney stones. The other study, in which investigators analyzed 24-hour urine specimens from non-Hispanic whites, demonstrated that age and sex influence the excretion of key urinary factors related to kidney stone risk.

The meta-analysis included 9 studies: 2 randomized controlled trials (RCTs) with 269 patients and 7 observational studies with 273,685 patients. High fluid intake— defined as intake sufficient to achieve a minimal urine volume of 2.0–2.5 L/day—was significantly associated with a 60% decreased risk of incident kidney stones in RCTs and a 51% decreased risk in observational studies. In addition, high fluid intake was significantly associated with a 60% decreased risk of recurrent stones in RCTs and an 80% decreased risk in observational studies.

In 2014, the American College of Physicians (ACP) released a new guideline for preventing recurrent kidney stones in adults. For patients who have had 1 or more prior kidney stone episodes, the guideline recommends increased fluid intake spread throughout the day to achieve a urine volume of at least 2 L/day.

Kidney stone specialist David S. Goldfarb, MD, clinical chief of nephrology at New York University Langone Medical Center in New York, pointed out the ACP's guidelines suggest that evidence for the efficacy of increasing fluid intake is weak and leave an impression that increasing fluid intake is not an important prescription for patients with kidney stones. “We know that it is an extremely important prescription, not just because it's efficacious, but because it's inexpensive and because it's safe,” Dr. Goldfarb said.

Randomized controlled trials have already provided convincing evidence of the safety and efficacy of increasing fluid intake, he said. Adding in what is understood about urine chemistry, “we know that increasing fluid intake leads to a reduction in supersaturation.”

The notion that more studies are needed to confirm that increasing fluid intake can prevent kidney stones is incorrect, said Dr. Goldfarb, who is president of the ROCK [Research on Calculus Kinetics] Society and director of kidney stone prevention and treatment programs at New York Harbor VA Healthcare System.

The new study provides “additional confirmatory evidence” of the safety and efficacy of high fluid intake for preventing kidney stones, he told Renal & Urology News.

Dr. Goldfarb's usual fluid prescription for kidney stone prevention is 96 ounces per day, assuming the weather is not very hot and the patient is not exercising too much or experiencing increased bowel losses of water. He typically instructs patients to think of 96 ounces in terms of 8 × 12 (8 12-ounce or 12 8-ounce portions). “You need a way to visualize this. “It's not enough to say to people, ‘drink a lot,' you have to say what a lot means.”

The other study by Dr. Lieske and colleagues, which was presented by Majuran Perinpam, BSc, included 416 female and 293 male subjects (mean age 64.6 and 66.5 years, respectively). Results showed that urinary calcium declined with age, and levels were higher in males than females. An increase in serum creatinine caused urine calcium to decrease. Urinary oxalate excretion was greater in males despite no difference in oxalate intake, “suggesting sex differences in metabolism or other food intake,” Dr. Lieske and his collaborators wrote in a poster presentation. Urinary uric acid excretion correlated positively with body mass index and estimated glomerular filtration rate (as calculated using cystatin C). Cystatin C correlations with uric acid may relate to hyperuricemia and inflammation, according to the researchers.

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