Kidney stones are small, hard deposits formed from concentrated minerals and salts within the urinary tract. These mineral concretions, often composed of calcium oxalate, can vary widely in size. Moving stones can obstruct the narrow tubes leading from the kidneys to the bladder, causing severe pain. Approximately one in ten people will experience a kidney stone, and over half a million individuals visit the emergency room (ER) annually for stone-related issues. Recognizing the difference between manageable pain and a complication requiring immediate medical attention is essential for protecting kidney health.
Common Symptoms of Kidney Stones
The hallmark sign of a kidney stone episode is renal colic, a sudden, intense pain that typically begins in the flank, just below the ribs. This pain often radiates downward toward the lower abdomen and groin as the stone moves through the ureter. The discomfort is often described as coming in waves, intensifying as the ureter contracts to push the stone along.
The severity of the pain is due to the blockage and subsequent pressure buildup within the kidney. Pain may be accompanied by secondary symptoms, such as nausea and vomiting, which are reflexive responses triggered by the intensity of the visceral pain. Patients may also notice hematuria, or blood in the urine, caused by the stone irritating the lining of the urinary tract. This gives the urine a pink, red, or brownish tint.
Other common symptoms include an urgent or frequent need to urinate, or a burning sensation during urination (dysuria), especially as the stone nears the bladder. While these symptoms are distressing and indicate an active stone event, they do not automatically require an ER visit if the pain is controlled and no signs of infection are present. Small stones have a good chance of passing spontaneously with conservative management.
Emergency Warning Signs That Require the ER
Certain symptoms signal a life-threatening complication that requires immediate emergency care, distinguishing the event from a typical stone passage. The most serious warning sign is the combination of pain and fever, often accompanied by chills or rigors. A fever indicates a potential infection behind the obstruction, a urological emergency that can rapidly progress to sepsis. This condition, known as pyelonephritis or urosepsis, requires urgent intervention to decompress the blocked kidney.
Patients must also seek immediate care if they experience intractable pain that is uncontrollable despite oral pain medications. Uncontrollable pain may suggest a stone too large to pass or a complete and severe obstruction. Furthermore, a complete inability to urinate, or significantly decreased urine output, is a sign of total obstruction that can quickly damage the affected kidney.
Persistent, severe vomiting that prevents the patient from keeping down any fluids is another red flag, as it can lead to severe dehydration. Dehydration can worsen kidney function during a stone event. Finally, any change in mental status, such as confusion, lethargy, or dizziness, may signal severe infection or shock and warrants an immediate trip to the ER. Patients who have only one functioning kidney or pre-existing conditions like diabetes are at a higher risk for complications and should seek medical attention sooner.
Initial Treatment and Assessment in the Emergency Room
Upon arrival at the ER, the initial goal is patient stabilization through prompt pain control and diagnostic assessment. Healthcare providers will administer intravenous (IV) fluids to correct dehydration and help flush the urinary system. Strong pain medication, such as IV non-steroidal anti-inflammatory drugs (NSAIDs) like ketorolac, is often given to alleviate the acute renal colic.
After initial pain management, assessment begins with blood work and a urinalysis to check kidney function and screen for infection. Blood tests measure creatinine levels to evaluate kidney function, while the urinalysis checks for blood, signs of infection, and the pH of the urine. Imaging is then used to confirm the diagnosis, determine the stone’s exact location, and assess the degree of obstruction.
A non-contrast computed tomography (CT) scan is the preferred imaging method for visualizing the stone. Alternatively, an ultrasound may be used, particularly in pregnant patients or those where radiation exposure is a concern. These tests help the medical team decide whether the stone is small enough for expected passage or if it requires immediate urological consultation for removal.
Home Management and Follow-Up Care
For individuals whose symptoms do not meet the ER criteria, home management focuses on pain control and facilitating the stone’s passage. Staying well-hydrated is paramount, requiring a daily intake of fluids, primarily water, to dilute the urine and encourage stone movement. Unless there are medical restrictions, patients should aim to drink enough fluid to keep their urine pale in color.
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be used to manage mild to moderate discomfort. In some cases, a physician may prescribe an alpha-blocker medication, such as tamsulosin, which relaxes the muscles in the ureter to expedite stone passage. Patients are often advised to strain their urine to catch the stone once it passes.
The collected stone should be taken to a healthcare provider for laboratory analysis. This analysis helps determine its composition and informs future prevention strategies. Even if the stone passes at home, it is important to schedule follow-up care with a primary physician or a urologist. This follow-up ensures that kidney function has returned to normal and allows for a metabolic workup to identify risk factors for future stones.