What Are Kidney Stone Symptoms, Causes, and Treatments

Introduction

Kidney stones are a common and painful problem that many people face. The pain can be sudden and intense, often starting in the lower back or side and moving toward the groin. For some, it can be so severe that they need to visit the hospital¹. Other kidney stone symptoms may include nausea, blood in the urine, and difficulty urinating². 

Kidney stones develop when minerals and salts in the urine become highly concentrated and crystallise, creating solid masses. While some stones pass without symptoms, others can obstruct urine flow, leading to intense pain, infection, or kidney damage. The number of people affected by kidney stones has been increasing steadily, largely due to factors such as inadequate hydration, poor dietary choices, and underlying metabolic disorders³. As a result, kidney stones treatment has become one of the most commonly sought services in urology¹.

What Are Kidney Stones?

Kidney stones are hard deposits that develop when minerals and salts in the urine become overly concentrated and crystallise. These crystals can bind together, forming stones within the kidneys. Some stones stay in the kidney without causing trouble, but others move into the ureter, the tube between the kidney and bladder. If a stone gets stuck there, it can block the flow of urine and cause a lot of pain. 

Kidney stones can affect overall health by causing urinary tract infections, kidney damage, and repeated trips to the emergency room. They are one of the most common conditions treated in urology, and their occurrence has been increasing. If not properly managed, they often recur¹. 

How Common Are Kidney Stones?

Kidney stones are a common health issue across the world, affecting people of all ages. They occur more often in adults and are more common in men than in women. In developed countries, the lifetime prevalence of kidney stones has doubled in recent decades, now affecting approximately 11% of men and 7% of women. One major reason for this is not drinking enough water, which makes the urine more concentrated and allows crystals to form¹. 

In regions like India, kidney stones affect nearly 12% of the population, especially in tropical and semi-arid areas. Factors such as a hot climate, rising temperatures, and dietary habits play a major role in the rising incidence of kidney stones. With rising rates of obesity, hypertension, and diabetes, the risk continues to grow³. 

Types of Kidney Stones

There are different types of kidney stones, each with distinct causes and characteristics, as follows: 

• Calcium Stones: These are the most common type, making up about 80% of cases, and are composed of calcium oxalate or calcium phosphate⁴. 
• Uric Acid Stones: These account for around 9% of stones and often occur in people with high purine intake or acidic urine⁴. 
• Struvite Stones: These account for about 10% of stones, can grow quickly, and are associated with urinary tract infections⁴. 
• Cystine Stones: These are rare, forming in about 1% of cases. They are caused by a genetic condition called cystinuria, which affects how the kidneys process certain amino acids⁴. 
• Drug-Induced Stones: These are also rare, seen in about 1% of people with kidney stones. They can be caused by certain medications like triamterene, sulfa drugs, or HIV treatment when taken in high doses⁵. 

Symptoms of Kidney Stones

People with kidney stones can experience a wide range of symptoms, from no signs at all to severe pain and, sometimes, serious complications. 

Pain-Related Symptoms

• Pain often begins suddenly or gradually and usually affects one side of the lower back or abdomen (unilateral colicky flank pain)⁴. 
• It is typically cramp-like in nature and tends to come and go⁴. 
• The pain may radiate to the lower abdomen, groin, or genitals, depending on the stone’s position⁴. 
• Many patients become restless and frequently change positions in an attempt to relieve the discomfort⁴. 
• Pain often peaks within 1-2 hours and may follow a pattern, starting intermittently, becoming constant, and then easing in waves over several hours⁶. 
• The pain may wake patients from sleep and is frequently accompanied by tenderness in the groin or pubic area⁶. 

Other Common Symptoms 

• Blood in the urine (haematuria): Seen in up to 90% of cases, the blood is usually microscopic and may be detected on a urine test⁴. 
• Urine may appear cloudy or have a strong, unpleasant odor². 
• Some people may feel a constant urge to urinate, experience burning or pain during urination, or pass only small amounts of urine at a time². 
• Nausea and vomiting may accompany the pain⁴. 
• Fever can occur in some individuals⁴. 
• Children may show different signs, such as excessive crying, irritability, vomiting, or fever⁴. 

Serious Symptoms 

• In severe cases, kidney stones can block urine flow from both ureters or trigger infections, leading to a buildup of waste products like creatinine and urea, increased acid levels, and fluid retention in the body^1,4,7. 
• This may lead to confusion, low blood pressure, or even sepsis, requiring urgent medical care⁴. 

Causes of Kidney Stones

Kidney stones form when minerals and other substances in urine become highly concentrated, leading to crystal formation. If you’ve ever wondered about the reasons for kidney stones occurrence, these are some of the most common ones^4,8: 

• Low Fluid Intake: Not drinking enough fluid reduces urine output, increasing the chance of stone formation. 
• High Oxalate Consumption: Found in foods like beans, chocolate, berries, some teas, spinach, potatoes, and soda. 
• High Salt and Animal Protein Intake: These increase calcium and uric acid in the urine, encouraging stone formation. 
• Increased Calcium Excretion by the Kidneys: Hypercalciuria (kidneys excreting excess calcium in urine)^, which may or may not be accompanied by excess calcium in blood. 
• Low Calcium Intake: Not getting enough calcium can increase oxalate absorption in the gut, leading to more stones. 
• Certain Infections: Some urinary tract infections can increase the pH of urine, leading to infection-related stones. 
• Certain Medications: Drugs used for HIV, infections, or long-term use of antibiotics like ceftriaxone can contribute to stone formation. 
• Congenital Conditions: A rare disorder called cystinuria, which often begins in childhood, causes a buildup of cystine, leading to stones. 

Risk Factors for Kidney Stones

Several lifestyle, metabolic, and medical factors can increase the risk of kidney stones, including⁴: 

• Obesity and Diabetes: Linked to changes in urine composition that promote both calcium and uric acid stones. 
• High Blood Pressure and Gout: These conditions are associated with increased calcium or uric acid levels in the urine. 
• Low Levels of Urine Citrate: Citrate normally does not allow crystal to clump together. Up to 60% of patients with calcium stones are seen to have low citrate levels. 
• Weight-Loss Surgeries: Procedures like gastric bypass and sleeve gastrectomy can lead to high urinary oxalate and low citrate levels. 
• Family or Personal History of Stones: Significantly increases the chance of recurrence. 
• Certain Diet Choices or Supplements: Vitamin C or fish oil can also play a role in stone development. 
• Other Health Conditions: Chronic kidney issues, cancers, and some digestive problems can also increase the risk of kidney stones. 
• Idiopathic Conditions: In some cases, stones occur without an identifiable underlying cause, but diet and genetics may still play a role. 

Complications of Kidney Stones

If not treated properly, kidney stones can cause a variety of short- and long-term health problems. While some stones resolve on their own, others may lead to serious complications requiring urgent care, such as⁴: 

• Urinary Obstruction: A stone can block the flow of urine, causing swelling in the kidney (hydronephrosis) and sharp pain. 
• Kidney Damage: Long-term blockage or repeated occurrence of stones may injure the kidneys and reduce their function and lead to kidney failure in the long term. 
• Infections: Stones can trap bacteria and lead to infections, which may result in fever, chills, or urinary tract infections (UTIs). 
• Sepsis: In severe cases, especially when the infection spreads, a life-threatening condition called sepsis can occur. 
• Chronic Kidney Disease: If left untreated, recurring or large kidney stones can gradually damage the kidneys and may eventually lead to kidney failure. 
• Recurrent Stones: Without addressing the underlying causes, stones can come back, sometimes within a few years. 
• Emergency Situations: Severe infections, very large stones, or complete blockage of urine can require urgent surgery or hospitalisation. 

Diagnosis of Kidney Stones

To diagnose kidney stones, doctors use a combination of laboratory tests and imaging techniques. 

Lab Tests

The following laboratory tests may be recommended to check for kidney stones⁴: 

• Urine Test (Urinalysis): Checks for blood, white blood cells, and signs of infection in the urine. 
• Additional Blood Tests: May include a complete blood count (CBC), kidney function tests, and tests for signs of infection or inflammation. 

Imaging Tests

Common imaging methods used for diagnosing kidney stones include⁴: 

• X-ray (KUB): This can show certain types of stones, especially those made of calcium. Often used to monitor stones over time. 
• Ultrasound: Commonly used in children and pregnant women to avoid radiation exposure during an X-ray. It helps detect stones in the kidneys or urinary tract and any swelling caused by blockage. 
• CT scan (without contrast): The most accurate test for detecting stones. It shows nearly all stone types and helps plan treatment. 
• MRI: Less commonly used, but safe for children and pregnant women. It can detect swelling but might miss some stones. 

Other Tools

• STONE Score: A risk assessment tool that is used to estimate the risk of a kidney stone based on symptoms like nausea, blood in urine, and the timing of pain⁴. 
• Metabolic stone work-up: This includes blood tests (to measure calcium, phosphorus, uric acid, and parathyroid hormone levels) and a 24-hour urine test (to check for calcium, citrate, uric acid, and oxalates). These tests help identify possible causes of kidney stone formation. 

Treatment Options

Treatment for kidney stones depends on their size, location, and whether they are causing symptoms or complications. The following options are commonly used to treat kidney stones, depending on the size of the stones and the severity of discomfort. 

• Managing Pain and Discomfort: Pain relief is usually a priority in individuals with kidney stones⁴. 
  • NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen, diclofenac, or ketorolac are commonly used to ease discomfort.  
  • If the pain is very severe, stronger painkillers like opioids like morphine or hydromorphone may be used.  
  • In some cases, a medicine called lidocaine can be given through a vein to help with pain.  
  • If nausea or vomiting occurs, antiemetic medications, such as ondansetron, metoclopramide, or promethazine, are commonly used to manage these symptoms. 
• Helping Stones Pass Naturally: Small stones often pass on their own over time. Certain medications may be suggested to help relax the urinary tract and encourage stone movement. To help pass stones that are 5–10 mm in size, alpha-blockers (which relax the urinary tract muscles) may be used. IV fluids help in the management of dehydration but don’t speed up stone passage⁴.  
• How Long Does It Take to Pass a Stone? 
  • Stones 2 mm or smaller: Usually pass in about 8 days 
  • 3 mm stones: Around 12 days 
  • 4–6 mm stones: May take 22 days 
  • Larger stones (7-9 mm): Less likely to pass without help⁴ 
• When Procedures Are Needed: If a stone is too large and causes severe symptoms or leads to complications like kidney blockage or infection, a procedure may be required. Depending on the situation, doctors may use special equipment to break or remove the stone through the urinary tract or a small incision in the back⁴. 
• Surgical Techniques to Remove Kidney Stones: 
  • ESWL (extracorporeal shock wave lithotripsy): Uses shock waves to break the stone into tiny pieces; however, it is not a commonly used treatment these days¹¹. 
  • Ureteroscopy: A thin tube is passed through the urinary tract to remove or break the stone with a laser¹¹. 
  • Percutaneous Nephrolithotomy: A small cut is made in the back to directly remove the stone from the kidney or upper ureters¹¹. 
  • The choice of procedure depends on: Stone size, location, and the individual’s overall health¹¹. 
• Emergency Situations: Infections or kidney blockages caused by stones may require urgent care to drain the urine and avoid permanent damage⁴. 
• Long-Term Management: Once the stone has passed or been removed, doctors may suggest lab tests to understand the cause and avoid the occurrence of future stones. Long-term care might include diet changes, lifestyle adjustments, or medications based on the stone type and overall health⁴. 

How to Prevent Kidney Stones

You may be able to avoid having kidney stones with some lifestyle changes. Here’s how you can lower the risk of developing stones in the future⁴: 

• Drinking Plenty of Fluids: Staying well-hydrated is considered an important step. Aim to drink enough water throughout the day to keep your urine clear or light yellow. This helps flush out substances that can form stones. 
• Eat a Balanced Diet:  
• Avoid eating too much salt or high-protein foods from animal sources. 
• Limit foods that are high in oxalates like spinach, chocolate, and certain nuts. 
• Don’t cut calcium completely: Getting the right amount helps reduce stone formation. 
• Maintain a Healthy Weight: Being overweight or having conditions like diabetes and high cholesterol can increase stone risk. A balanced diet and regular exercise help reduce that risk. 
• Be Cautious with Certain Medications: Some medications can increase the risk of kidney stones, especially if taken over a long period. Always discuss your treatment options with your doctor. 
• Regular Follow-Up: If you’ve had a kidney stone before, follow-up care is important. Your doctor may recommend tests to find the cause and create a plan to avoid future stones. 

When to See a Doctor

If you or your child experience any of the following symptoms, it may indicate the presence of a kidney stone⁴: 

• Sudden, sharp pain in the lower back or side 
• Pain that spreads to the lower abdomen or groin 
• Blood in the urine (it may appear pink, red, or brown) 
• Nausea or vomiting that doesn’t go away 

It’s important to consult with a doctor promptly if⁴: 

• The pain is severe and not improving with rest or fluids 
• You have a history of kidney stones and symptoms have returned 
• There are signs of infection such as fever, chills, or cloudy, foul-smelling urine 
• You are unable to urinate or notice a significant decrease in urine output 

In these cases, early medical attention can help avoid complications like urinary blockage, kidney infection, or long-term kidney damage. Timely diagnosis and treatment also improve the chances of passing the stone naturally and reduce the risk of future episodes. 

Conclusion

Kidney stones form when minerals build up in the urine and can cause intense pain, nausea, or blood in the urine. They are increasingly common, especially in hot climates or among people with inadequate hydration. Common kidney stone causes include low fluid intake, high salt or protein diets, and certain medical conditions like obesity or urinary infections. While small stones may pass on their own, larger ones might block urine flow or lead to infections, requiring urgent care. Diagnosis is usually based on imaging and lab tests and treatment may range from supportive care to procedures as advised by a doctor. Hydration, diet, and follow-up care can help avoid the recurrence of kidney stones. Early medical attention is key to avoiding complications. 

Frequently Asked Questions (FAQs)

References

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