Kidney Stones: Symptoms, Causes and When to See a Urologist

If you have ever had it, you remember it. Kidney stone pain arrives suddenly, usually in the side or the small of the back, and it does not settle when you lie down or change position. People often describe pacing the room at 2 a.m. because nothing helps. That last detail is the most useful clue we have for telling stone pain apart from a muscular back problem, which almost always eases in some position.

This guide covers what the pain actually means, which stones need treatment and which do not, and the point at which it is worth having a urologist look at your scan.

What a kidney stone actually is

Urine carries dissolved minerals — calcium, oxalate, uric acid, phosphate. When there is too little water to keep them dissolved, they crystallise, and crystals clump into a stone. Most stones form in the kidney and cause no trouble while they sit there. The pain begins when one moves into the ureter, the narrow tube to the bladder, and blocks it. The kidney keeps producing urine with nowhere to send it, pressure builds, and that pressure is what you feel.

This matters for a practical reason: the size of the pain does not tell you the size of the stone. A 4 mm stone wedged in a narrow stretch of ureter can be agonising, while a 15 mm stone sitting quietly in the kidney may cause nothing at all until it is found on a scan done for another reason.

Symptoms worth paying attention to

• Sharp pain in the side or back, often below the ribs, that comes in waves and may travel down towards the groin
• Pain that does not settle with position — the distinguishing feature from most muscular back pain
• Blood in the urine, sometimes visible as pink or brown, sometimes only on a test
• Burning when passing urine, or a persistent urge to go with very little coming out — though a persistently weak stream without pain points elsewhere
• Nausea and vomiting alongside the pain, which is common and not a sign of something separate
• Cloudy or foul-smelling urine, which suggests infection as well as a stone

When it is an emergency

Most stone pain can wait for a clinic appointment the same day or the next. Three situations cannot:

1. Fever or chills with the pain. A blocked kidney plus infection can turn serious within hours and needs drainage, not painkillers.
2. Passing very little or no urine, particularly if you have one working kidney.
3. Pain severe enough that you cannot keep down fluids or oral medication.

Any of these means going to a hospital emergency department, not waiting for an OPD slot.

Why stones are so common in Hyderabad

Two reasons, and both are about water. The first is heat: from March to June, a lot of fluid leaves as sweat rather than urine, so urine becomes concentrated. The second is habit — most people simply drink less than they think. Add a diet high in salt, and the calcium load in the urine rises with it.

Family history matters too. If a parent or sibling has formed stones, your risk is meaningfully higher, and it is worth being deliberate about fluids rather than waiting for a first episode.

How stones are diagnosed

For a first episode, an ultrasound of the abdomen with a plain KUB X-ray is usually enough to confirm a stone and show whether the kidney is swollen. It involves no radiation dose worth worrying about and is widely available.

A non-contrast CT (CT KUB) is more accurate — it finds small stones and stones the ultrasound cannot see, and gives an exact size and position. We ask for it when the diagnosis is unclear, when we are planning surgery, or when someone has had several episodes.

Alongside imaging, a urine test and a blood creatinine tell us whether there is infection and how the kidneys are coping.

Which stones need treatment

The decision rests on size, position, and whether the kidney is obstructed.

Stone size	Usual approach
Under 5 mm	Usually passes on its own with fluids and medication
5–10 mm	May pass; often needs a procedure if it does not move in a few weeks
Over 10 mm	Unlikely to pass; a procedure is usually the right answer
Any size with infection or a blocked kidney	Needs urgent drainage regardless of size

Waiting has a cost that is easy to underestimate. A ureter blocked for many weeks can leave the kidney permanently weakened, and that damage does not reverse once it has happened. This is why “I will manage with painkillers until it passes” is safe for a small stone and genuinely risky for a large one.

Treatment options, in plain terms

None of the routine treatments involve cutting the abdomen open.

RIRS (retrograde intrarenal surgery). A thin flexible scope is passed up through the natural urinary passage to the kidney, and the stone is broken with a laser. No external cut at all. Suited to kidney stones up to around 2 cm, and usually a day-care or overnight stay.

URSL. The same idea for a stone sitting in the ureter — scope up, laser it, remove the fragments.

PCNL. For large kidney stones, generally over 2 cm. A small keyhole is made in the back to reach the kidney directly. It is the most effective option for a big stone burden and involves a short hospital stay.

Medical management. For small stones, medication that relaxes the ureter plus a deliberate increase in fluids. It works, but only if the stone is genuinely small and the kidney is not obstructed.

A stent — a soft tube keeping the ureter open — is often placed after a procedure and removed a week or two later. It is normal, temporary, and the mild urgency it causes settles as soon as it comes out.

Stopping the next one

Removing a stone treats today’s problem. It does nothing about the chemistry that produced it, and roughly half of stone formers make another within a decade. What actually reduces recurrence:

• Fluid, first and above everything else. Aim to pass around 2.5 litres of urine daily. Colour is a better guide than counting glasses.
• Cut salt before you cut calcium. High sodium pushes calcium into the urine. Restricting dietary calcium usually backfires and raises oxalate absorption instead.
• Moderate oxalate-heavy foods if you form calcium oxalate stones — spinach, beetroot, nuts, excessive tea. Moderate, not eliminate.
• Add citrate. Lemon or lime juice in water genuinely inhibits stone formation, and it is the cheapest intervention available.
• Get the stone analysed if you can catch it. Knowing whether it was calcium oxalate, uric acid or another type changes the advice completely.

When to see a urologist in Uppal

Book an appointment if any of these apply:

• You have had one episode of stone pain, whether or not it settled
• A scan has shown a stone, even without symptoms
• You have had two or more stones — the pattern matters more than any single episode
• There is blood in your urine that has not been explained
• You have been told about a stone and simply want a clear answer on whether it needs treatment

At UNO Super Speciality Clinics in Uppal, Dr. Srikanth Munna consults Monday to Saturday, 6–9 PM, opposite the Uppal bus stop. Bring any scans and reports you already have — most consultations end with a clear plan, and for a large share of patients that plan does not involve surgery.

If you are unsure whether what you felt was a stone, message the clinic on WhatsApp and describe it. That is usually enough to say whether a scan is worth doing.