Kidney Stones: Symptoms, Causes, Diagnosis and Treatment

Kidney stones are hard deposits of minerals and salts that form inside the kidneys. They can remain in the kidney without causing symptoms or move into the ureter, the tube that carries urine to the bladder. When a stone blocks urine flow, it can cause severe pain, blood in the urine and other urinary problems.

Some kidney stones pass naturally with medical guidance, while others require treatment to break them into smaller pieces or remove them. Modern urology offers several minimally invasive treatment options, including RIRS, URS, ESWL and PCNL. The right approach depends on the stone’s size, location, composition, symptoms and whether it obstructs the urinary tract.

At Jyoti Hospital, Gurugram, the Department of Urology provides evaluation and treatment for urinary stone disease. The hospital’s listed endourological services include flexible ureteroscopy (RIRS), ureteric stone surgery (URS), PCNL and ESWL/lithotripsy. Our urology team evaluates each patient’s condition to help determine an appropriate treatment approach.

What Are Kidney Stones?

Kidney stones, medically known as renal calculi, develop when certain minerals and other substances become concentrated in urine and form crystals. Over time, these crystals can grow into hard stones.

Stones vary in size. Some are as small as grains of sand, while others can grow large enough to occupy a significant part of the kidney.

A small kidney stone may pass through the urinary tract without causing noticeable symptoms. However, a stone lodged in the ureter can obstruct urine flow and trigger intense pain, commonly called renal colic.

Kidney stones can affect one or both kidneys. They may also occur in other parts of the urinary tract, including the ureters and bladder.

What Are the Symptoms of Kidney Stones?

Kidney stone symptoms vary according to the stone’s size, location and degree of obstruction. Some people have no symptoms until a stone moves or blocks urine flow.

Common symptoms include:

• Severe pain in the back or side: Pain often develops below the ribs and may spread towards the lower abdomen or groin.
• Pain that comes in waves: The intensity may increase and decrease as the ureter contracts around a stone.
• Blood in the urine: Urine may appear pink, red or brown, although bleeding may only be detectable on testing.
• Painful urination: A stone near the bladder may cause burning or discomfort while passing urine.
• Frequent or urgent urination: A stone close to the bladder can create a persistent urge to urinate.
• Nausea and vomiting: Severe pain may trigger digestive symptoms.
• Cloudy or foul-smelling urine: These changes may occur with a urinary infection or another urinary condition.
• Difficulty passing urine: A stone may interfere with urine flow, particularly if it causes significant obstruction.

These symptoms do not always indicate a kidney stone. Urinary tract infections and other conditions can produce similar problems, so medical assessment is important.

When Should You Seek Medical Attention?

Kidney stones can sometimes cause serious complications, particularly when they obstruct urine flow or occur alongside an infection.

Seek emergency medical care if you experience:

• Fever or chills along with suspected kidney stones.
• Severe or persistent pain that is difficult to control.
• Repeated vomiting or an inability to keep fluids down.
• Inability to pass urine or a marked reduction in urine output.
• Symptoms of a kidney stone if you have a single functioning kidney or significant kidney disease.

A blocked urinary tract with an infection is a medical emergency. It may require urgent drainage and antibiotic treatment. Do not wait for the stone to pass naturally if you have fever, chills or other signs of serious illness.

What Causes Kidney Stones?

Kidney stones develop when urine contains more stone-forming substances than it can keep dissolved. These substances may form crystals that gradually grow into stones.

Several factors can increase the likelihood of stone formation.

1. Inadequate Fluid Intake: When you do not drink enough fluids, your urine becomes more concentrated. This makes it easier for minerals and salts to crystallise.
   • The risk may increase during hot weather, heavy physical activity or work that causes substantial sweating without adequate fluid replacement.
2. High Salt Intake: Excess sodium can increase the amount of calcium excreted in urine, which may contribute to calcium-based kidney stones.
   • Frequent consumption of salty snacks, processed foods, pickles and heavily salted meals may increase sodium intake.
3. Dietary Factors: Diet influences stone risk, but the effect depends on the type of stone and the individual’s metabolism.
   • A high intake of animal protein, excessive sodium and certain foods rich in oxalate may contribute to stone formation in susceptible people.
4. Family History: People with a family history of kidney stones may have a greater likelihood of developing them. In some cases, inherited conditions affect how the body handles minerals and other substances in urine.
5. Previous Kidney Stones: Once you have developed a kidney stone, you may be more likely to develop another. Understanding the stone’s composition and addressing underlying risk factors can help reduce recurrence.
6. Certain Medical Conditions: Conditions associated with a higher risk of kidney stones include:
   • Obesity and metabolic syndrome.
   • Gout and elevated uric acid.
   • Certain disorders of calcium metabolism.
   • Recurrent urinary tract infections.
   • Some digestive diseases or intestinal surgeries that affect fluid and mineral absorption.
   • Certain inherited metabolic conditions.
7. Certain Medicines and Supplements: Some medicines and supplements can alter urine chemistry or contribute to stone formation in susceptible individuals.
   • Do not stop a prescribed medicine independently. If you have recurrent stones, discuss your medicines and supplements with our doctor.

What Are the Different Types of Kidney Stones?

Identifying the type of kidney stone helps doctors understand why it formed and how to prevent another.

• Calcium Stones: Calcium stones are the most common type. They usually contain calcium oxalate and sometimes calcium phosphate.
  • Factors such as high urinary calcium, low fluid intake, high sodium intake and certain metabolic conditions may contribute to their formation.
  • Most people with calcium stones should not eliminate normal dietary calcium without medical advice. Adequate dietary calcium can help reduce oxalate absorption in the intestine.
• Uric Acid Stones: These stones can form when urine is persistently acidic or contains high concentrations of uric acid.
  • Associated factors increases the risk for uric acid stones such as gout, certain dietary patterns and metabolic conditions. Selected patients may benefit from medicines that change urine chemistry.
• Struvite Stones: These stones are associated with certain urinary tract infections. They may grow rapidly and, in some cases, occupy a large portion of the kidney.
  • Treatment often requires removal of the stone and appropriate management of the infection.
• Cystine Stones: Cystine stones are uncommon and occur in people with an inherited condition called cystinuria, which causes excess cystine to enter the urine.
  • These stones may recur and often require specialised long-term prevention strategies.

How Are Kidney Stones Diagnosed?

Our doctors diagnose kidney stones using symptoms, medical history, examination, laboratory tests and imaging studies.

1. Medical History and Physical Examination

Our doctor ask about:

• The location, duration and severity of your pain.
• Blood in the urine or changes in urination.
• Fever, chills, nausea or vomiting.
• Previous kidney stones or urinary infections.
• Family history of kidney stones.
• Daily fluid intake and dietary habits.
• Existing medical conditions, medicines and supplements.

2. Urine Tests

Urinalysis can detect blood, white blood cells, crystals and other findings that may support the diagnosis.

If an infection is suspected, a urine culture helps identify the bacteria responsible and guide antibiotic treatment.

3. Blood Tests

Depending on the clinical situation, blood tests may assess kidney function, electrolytes, calcium and uric acid.

These tests help identify complications and possible metabolic factors that contribute to stone formation.

4. Ultrasound

Ultrasound can identify many kidney stones, swelling of the urinary tract and some signs of obstruction without using ionising radiation. However, ultrasound may not detect every ureteric stone.

5. CT Scan

A non-contrast CT scan is highly accurate for detecting and locating kidney and ureteric stones. It can help establish stone size, position and the degree of obstruction.

Our doctors will recommend a CT scan when symptoms are severe, the diagnosis remains uncertain or detailed information is needed to plan treatment. The choice of imaging depends on the patient’s age, pregnancy status, clinical circumstances and previous investigations.

6. Stone Analysis and Metabolic Evaluation

If you pass or undergo removal of a stone, your doctor may recommend laboratory analysis to identify its composition.

People with recurrent stones, high-risk features or certain medical conditions may also need a more detailed metabolic evaluation, sometimes including urine collection over 24 hours.

These findings can guide a personalised prevention plan.

What Are the Treatment Options for Kidney Stones?

Kidney stone treatment depends on the stone’s size, location, composition, symptoms and the patient’s overall health.

Some small stones pass naturally and may only require monitoring and symptom control. Larger stones, persistent obstruction, uncontrolled pain or an associated infection may require a procedure.

The four commonly used procedures are RIRS, URS, ESWL and PCNL. Although all aim to help remove or clear stones, they work in different ways and suit different clinical situations.

1. Observation and Medical Management

Some small stones can pass naturally through the urinary tract.

When observation is appropriate, the doctor may recommend:

• Suitable pain relief.
• Anti-nausea medicines if needed.
• Appropriate fluid intake according to the patient’s condition.
• Follow-up imaging or review to confirm that the stone has passed or that obstruction has resolved.
• Selected medicines to facilitate the passage of certain ureteric stones.

Alpha-blockers may help selected patients pass some ureteric stones, particularly stones in the lower ureter. Their suitability depends on the stone’s characteristics and the patient’s clinical circumstances.

Do not assume that every stone will pass naturally. A stone may remain lodged even if the pain improves, so follow-up is important when advised.

2. RIRS (Retrograde Intrarenal Surgery)

RIRS is a minimally invasive procedure used to treat kidney stones by reaching the kidney through the natural urinary passage.

During RIRS, the urologist passes a thin, flexible instrument called a ureteroscope through the urethra and bladder, then advances it through the ureter into the kidney. The surgeon uses a camera to locate the stone and usually employs a laser to break it into smaller fragments.

The fragments may be removed with specialised instruments or left small enough to pass in the urine, depending on the stone and the treatment plan.

When may RIRS be recommended?

Doctors may consider RIRS for:

• Kidney stones that require active treatment but are suitable for a flexible endoscopic approach.
• Selected stones in the kidney’s lower pole.
• Stones for which ESWL may be less effective because of their size, hardness or location.
• Selected patients in whom another procedure may carry additional risks.

RIRS is performed through the urinary tract, so it does not require an incision through the skin into the kidney. However, some patients need a temporary ureteric stent to support urine drainage after treatment.

Benefits and considerations

RIRS avoids a skin incision and can treat stones in several parts of the kidney. However, larger or multiple stones may require more than one session. Possible complications include bleeding, infection, ureteric injury and stent-related discomfort.

3. URS (Ureteroscopy)

URS is an endoscopic procedure used primarily to treat stones in the ureter, although it can also be used for selected kidney stones.

The urologist passes a thin instrument through the urethra and bladder into the ureter to locate the stone. The surgeon may use a laser or another stone-breaking device to fragment it, then remove the pieces with a small retrieval instrument when appropriate.

Rigid or semi-rigid ureteroscopes are commonly used for many ureteric stones. Flexible instruments may be used when the stone’s location requires greater manoeuvrability.

When may URS be recommended?

Doctors may consider URS when:

• A ureteric stone is unlikely to pass naturally.
• Pain persists despite appropriate medical treatment.
• A stone causes ongoing obstruction.
• ESWL is unsuitable or has not successfully cleared the stone.
• A higher likelihood of clearing a ureteric stone in one procedure is an important consideration.

Benefits and considerations

URS allows the surgeon to directly visualise and treat the stone. It often offers a good chance of stone clearance in one procedure, although outcomes depend on the stone and the clinical circumstances.

A temporary ureteric stent may be placed after treatment, but it is not necessary in every uncomplicated case. Possible complications include urinary infection, bleeding, ureteric injury and temporary discomfort during urination.

RIRS vs URS: What is the difference?

RIRS is a specialised form of flexible ureteroscopy used to access stones inside the kidney. URS commonly refers to endoscopic treatment of stones in the ureter. Both use instruments passed through the natural urinary passage, but the target location and the instruments used may differ.

4. ESWL (Extracorporeal Shock Wave Lithotripsy)

ESWL breaks kidney or ureteric stones into smaller fragments using shock waves generated outside the body.

The treatment team locates the stone using imaging and directs shock waves towards it. The resulting fragments can then pass through the urinary tract in the urine.

ESWL does not usually require an incision, and some patients can undergo it without an overnight hospital stay.

When may ESWL be recommended?

Doctors may consider ESWL for selected kidney or ureteric stones when the stone’s size, location, composition and other patient factors make shock-wave treatment suitable.

Its effectiveness can be lower for very hard stones, certain lower-pole kidney stones, larger stones or stones that are difficult to target. The patient’s anatomy and body habitus may also affect treatment success.

Benefits and considerations

ESWL is non-invasive and generally involves less instrumentation inside the urinary tract than endoscopic procedures. However, some patients require repeat sessions or another procedure to clear the remaining fragments.

Possible effects include temporary blood in the urine, discomfort as fragments pass and, occasionally, obstruction caused by accumulated fragments. Your doctor will explain the expected results and follow-up requirements.

5. PCNL (Percutaneous Nephrolithotomy)

PCNL is a procedure commonly used to remove large or complex kidney stones.

Unlike RIRS and URS, PCNL involves creating a small opening through the skin of the back into the kidney. The surgeon passes specialised instruments through this tract to break up and remove the stone.

The procedure is generally performed under anaesthesia and may require a hospital stay, depending on the patient’s condition and the complexity of treatment.

When may PCNL be recommended?

Doctors commonly consider PCNL for:

• Large kidney stones, particularly those larger than 2 cm.
• Complex stones, including some staghorn stones.
• A large stone burden that may be difficult to clear using other procedures.
• Selected stones that have not responded adequately to other treatment methods.

Benefits and considerations

PCNL can remove a substantial amount of stone material and is often the preferred approach for large kidney stones. However, it is more invasive than ESWL, RIRS or standard URS and carries risks such as bleeding, infection and injury to nearby structures.

The recovery period and hospital stay depend on the stone burden, surgical findings and the patient’s overall health.

6. Medicines for Selected Stone Types

Some stones may respond to medical treatment that changes urine chemistry.

For example, selected uric acid stones can sometimes be dissolved by carefully supervised urine alkalinisation. This approach is not suitable for every stone type and requires appropriate monitoring.

Antibiotics treat bacterial infections when indicated; they do not dissolve ordinary kidney stones.

Which Kidney Stone Treatment Is Best?

There is no single treatment that is best for every kidney stone. Your urologist will consider the stone’s size and location, symptoms, anatomy, kidney function, infection risk and previous treatment history.

Treatment	How it works	Common use
Observation and medical management	Supports natural passage and controls symptoms	Selected small stones likely to pass
RIRS	Flexible endoscope reaches the kidney through the urinary tract; laser breaks the stone	Selected kidney stones
URS	Endoscope reaches the ureter; the stone is broken or removed	Many ureteric stones and selected kidney stones
ESWL	External shock waves break the stone into fragments	Selected kidney and ureteric stones
PCNL	Instruments enter the kidney through a small opening in the back	Large or complex kidney stones

In general, PCNL is commonly recommended as the first-line procedural treatment for kidney stones larger than 2 cm. RIRS and ESWL may suit selected smaller stones, while URS is often used for stones in the ureter. These are broad principles, not fixed rules; our urologist will individualise the treatment plan.

Can Kidney Stones Damage the Kidneys?

Small stones that pass without complications may not cause lasting kidney damage. However, prolonged obstruction can impair kidney function, particularly when it affects both kidneys or the only functioning kidney.

An obstructed urinary tract complicated by infection can become life-threatening without urgent treatment.

Seek timely medical care if you have persistent pain, fever, reduced urine output or a diagnosed stone that has not passed as expected.

How Can You Prevent Kidney Stones?

Kidney stones can recur, but lifestyle changes and targeted medical treatment can reduce the risk for many people.

• Drink Enough Fluids: Adequate fluid intake helps dilute urine and reduces the concentration of stone-forming substances.
  • Your fluid needs depend on your body size, activity level, climate and medical conditions. People who have been advised to restrict fluids because of heart or kidney disease should follow their clinician’s guidance.
• Reduce Excess Salt: A lower-sodium diet can help reduce urinary calcium in many people who form calcium stones.
  • Limit heavily salted packaged foods, frequent salty snacks and excessive added salt.
• Maintain Adequate Dietary Calcium: Do not eliminate calcium-rich foods simply because you have calcium stones. Normal dietary calcium can help bind oxalate in the gut and may reduce its absorption.
  • Discuss calcium supplements with our doctor, particularly if you have a history of stones.
• Moderate Animal Protein: Excessive animal protein intake may increase stone risk in some people. Aim for a balanced diet and discuss appropriate protein intake if you have recurrent stones or an underlying medical condition.
• Tailor Your Diet to Your Stone Type: People who form calcium oxalate stones may need guidance about selected oxalate-rich foods. Those with uric acid stones may need a different dietary and medical approach.
  • Dietary changes should reflect your stone analysis and metabolic evaluation rather than a generic list of foods to avoid.
• Consider Preventive Medicines When Needed: Some people with recurrent kidney stones need medicines to alter urine chemistry or reduce the amount of stone-forming substances in their urine.
  • Our doctor recommend urine testing and periodic follow-up to determine whether prevention is working.

How Jyoti Hospital Can Help

Kidney stone symptoms can range from mild discomfort to severe pain requiring urgent assessment. Identifying the stone’s location, size and possible complications helps guide appropriate treatment.

At Jyoti Hospital, Gurugram, patients can seek medical evaluation for urinary symptoms and discuss suitable diagnostic and treatment pathways with their treating team.

A consultation may help determine:

• Whether the symptoms are consistent with kidney or ureteric stones.
• Which investigations may be appropriate.
• Whether observation, medicines or a procedure should be considered.
• Which treatment options may suit the stone’s size and location.
• What steps may reduce the risk of future stones.

If you have severe pain with fever or chills, persistent vomiting, or an inability to pass urine, seek urgent medical care rather than waiting for a routine appointment.

Final Thoughts

Kidney stones form when minerals and salts crystallise in urine. Although some stones pass naturally, others can cause severe pain, urinary obstruction, infection and potential kidney damage.

Treatment options include observation, medicines, RIRS, URS, ESWL and PCNL. Each approach has specific uses, benefits and limitations. Appropriate imaging and medical assessment help determine which treatment is most suitable.

At Jyoti Hospital, Gurugram, the Department of Urology lists multiple approaches to kidney and ureteric stone treatment, including minimally invasive endourological procedures and ESWL/lithotripsy. If you suspect a kidney stone, seek a urological evaluation to understand the available options and develop a treatment plan suited to your condition.

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FAQs

1. What are the first signs of kidney stones?
   • Early symptoms may include pain in the side or back, blood in the urine, painful urination or an increased urge to urinate. Some stones cause no symptoms until they move or obstruct urine flow.
2. Can kidney stones pass naturally?
   • Yes. Some small stones pass naturally, but the likelihood depends on their size, location and other clinical factors. Follow-up may be needed to confirm passage and ensure that obstruction has resolved.
3. Is surgery always necessary for kidney stones?
   • No. Some stones can be managed with observation and medicines. Procedures such as RIRS, URS, ESWL or PCNL may be required when stones are unlikely to pass, cause persistent obstruction, produce uncontrolled symptoms or pose a risk to kidney function.
4. Can drinking water dissolve kidney stones?
   • Water helps dilute urine and may support the natural passage of suitable stones, but it does not dissolve every type of kidney stone. Certain uric acid stones may be dissolved with medically supervised treatment that changes urine chemistry.
5. Can kidney stones come back after treatment?
   • Yes. Treatment removes or helps pass the existing stone but does not always eliminate the factors that caused it. Stone analysis, adequate hydration, dietary changes and selected preventive medicines can help reduce recurrence.