Kidney Stones

Symptoms

• Severe Flank or Back Pain: Intense pain in the side and back below the ribs that often comes in waves and fluctuates in intensity as the stone moves through the urinary tract.
• Pain Radiating to the Groin: Pain that spreads from the back or side into the lower abdomen and groin, shifting location as the stone travels down the ureter.
• Blood in the Urine: Urine that looks pink, red, or brown, or blood detected on testing, caused by the stone irritating the lining of the urinary tract.
• Nausea and Vomiting: Feeling sick to your stomach or vomiting, which commonly accompanies severe stone pain.
• Painful or Frequent Urination: Burning with urination, a persistent urge to go, or passing only small amounts at a time, especially once the stone nears the bladder.
• Cloudy or Foul-Smelling Urine: A possible sign that infection has developed along with the stone, which raises the urgency of getting evaluated.

When it's an emergency

Come straight to Bellaire ER: open 24/7, if you have severe pain in your back, side, or groin that you cannot get comfortable with, especially if it comes in waves and is joined by nausea or vomiting you cannot control. Kidney stone pain is among the most severe pain people experience, and IV medication in the ER can control it while imaging confirms what is happening.

Seek emergency care immediately if you have a fever and chills along with stone symptoms. A stone that blocks the kidney while infection builds behind it can lead to sepsis, and it is a true emergency that needs urgent diagnosis and often urgent drainage at a hospital. Bellaire ER confirms the blockage and infection on-site, starts antibiotics and IV treatment, and arranges rapid transfer when drainage is required.

Other red flags include blood in your urine with severe pain, difficulty or inability to urinate, or stone symptoms when you have only one working kidney, are pregnant, or have diabetes or a weakened immune system. When in doubt, it is safer to be evaluated than to try to ride out the pain at home.

When it's not an emergency

Not every kidney stone needs an emergency visit. If you have a known small stone, your pain is mild and controlled with over-the-counter medication, and you are drinking fluids, keeping them down, and urinating normally with no fever, it is often reasonable to follow the plan your doctor or urologist gave you.

A telemedicine visit or a call to your primary care doctor is a sensible first step for mild, intermittent discomfort, questions about a previously diagnosed stone, or follow-up on prevention. Many small stones pass on their own with time, fluids, and oral pain control.

The picture changes quickly if pain becomes severe or unrelenting, vomiting keeps you from holding down fluids, you develop a fever, or you stop passing urine. Any of those changes means stop waiting and come to the ER.

What else could be causing this

A stone passing down the ureter

The diagnosis itself, and the reference point for everything else on this list. Pain comes in waves in the flank and side, radiates toward the groin and shifts as the stone moves, and brings nausea and blood in the urine. The restlessness is characteristic: people with stone pain pace and change position constantly because nothing helps.

Kidney infection

Pyelonephritis produces flank pain, fever, chills and feeling systemically unwell, usually with burning or frequency beforehand. The pain is steadier than stone pain rather than coming in waves. It matters a great deal whether an infection is sitting behind a blocking stone, because that combination is the dangerous one.

Abdominal aortic aneurysm

A weakened, bulging segment of the main artery in the abdomen. A leak causes sudden severe flank, abdominal or back pain and is mistaken for a first kidney stone often enough to be a recognized trap: particularly in an older adult, a smoker, or someone with high blood pressure. A first episode of stone-like pain after about 50 is imaged rather than assumed.

Musculoskeletal back and flank pain

A strained muscle or an irritated facet joint. The pain is usually reproducible, a particular movement or pressing on the spot recreates it, and it changes with position rather than coming in waves. There is no blood in the urine and no nausea, which is the practical separation.

Gallbladder and biliary disease

Gallstones blocking the gallbladder outlet cause severe right upper abdominal pain, often after a fatty meal, sometimes radiating to the right shoulder blade. It is confused with a right-sided kidney stone because both produce severe one-sided pain with vomiting, but the location is higher and more anterior, and the urine is clear.

Appendicitis

An appendix that sits behind the colon can produce right flank pain rather than the classic lower right abdominal pain, and appendicitis can even put blood and white cells in the urine by irritating the ureter. Pain that builds steadily and worsens with movement, rather than coming in waves, points this way.

Ovarian cyst, torsion and ectopic pregnancy

A ruptured or bleeding ovarian cyst and a twisted ovary both cause sudden severe one-sided lower pain with nausea. In anyone of childbearing age, an ectopic pregnancy is the one that cannot be missed, because a rupture bleeds internally. A pregnancy test is run on every such presentation before anything is assumed.

Testicular torsion

A twisted testicle cuts off its own blood supply and refers pain upward into the lower abdomen and groin, so it can be described as stone pain. It is a time-critical diagnosis with a narrow window to save the testicle, and it is why sudden groin pain in a boy or young man is examined directly rather than treated as a presumed stone.

Shingles

Herpes zoster affecting a nerve root in the flank causes burning, band-like one-sided pain that can precede the rash by several days. It has no urinary findings and no nausea, and once the blisters appear in a single stripe the diagnosis is obvious, the difficulty is only in the days before that.

What happens when you arrive

At Bellaire ER, a board-certified emergency physician evaluates your pain, examines you, and gets testing started quickly, because uncontrolled stone pain should not wait. Urine testing checks for blood and signs of infection, and blood work assesses your kidney function and looks for evidence of infection.

CT scanning is the standard test for diagnosing kidney stones, and our CT scanner is on-site, so you get an answer in a single visit. Imaging shows the size and location of the stone and whether it is blocking the kidney, which is exactly what determines the right treatment.

Treatment typically starts with IV pain medication, anti-nausea medication, and fluids, and most stones ultimately pass on their own. If your stone is small, we control your symptoms and send you home with a clear plan, medication, and instructions for follow-up. If the stone is large, blocking the kidney, or accompanied by infection, we start antibiotics when needed and coordinate prompt urology care or hospital transfer for procedures such as lithotripsy or ureteroscopy.

Tests we can run on site

CT scan

The standard test for diagnosing a kidney stone. It shows the stone itself, its exact size and position, and whether urine is backing up because the ureter is blocked, the three facts that determine whether a stone is likely to pass on its own or needs a urologist. It also identifies the serious alternatives, including an aortic aneurysm.

Urinalysis

Blood in the urine supports a stone, though its absence does not exclude one. More importantly, white cells, bacteria and nitrites point to infection, and infection combined with a blocked kidney is the finding that turns a painful night into an emergency.

Urine culture

Identifies the specific bacterium and which antibiotics will treat it. It is sent whenever infection is suspected, because the result guides treatment over the following days even though it is not back during the visit.

Complete blood count

A raised white cell count supports infection rather than a stone alone. It is read alongside the urine and the imaging rather than on its own, since pain itself can nudge the count upward.

Comprehensive metabolic panel

Measures kidney function and electrolytes. A rising creatinine shows that the blockage is affecting the kidney, which is a different situation from a painful stone that is still letting urine through, and it matters particularly for anyone with one working kidney or pre-existing kidney disease.

Pregnancy test

Run for every patient of childbearing age. It excludes an ectopic pregnancy as the cause of one-sided pain, and it determines the imaging: in pregnancy, ultrasound is used in place of CT.

Ultrasound

Sound-wave imaging with no radiation. It shows urine backing up in the kidney and can see larger stones, and it is the first-line test in pregnancy and in children. It is less reliable than CT at finding small stones in the ureter, which is why it supplements rather than replaces it in most adults.

Treated here, or transferred

Bellaire ER is a licensed freestanding emergency room: board-certified emergency physicians and nurse practitioners, on-site CT, X-ray, ultrasound and laboratory, medication administered during your visit, open 24 hours a day, 365 days a year, for adults and children. It is equipped to evaluate, stabilize and treat, and it is not a hospital. With kidney stones that division is unusually clean, and it is worth knowing which side of it you are on.

What happens here is diagnosis and pain control, and for most stones that is the whole of the treatment required. On-site CT establishes the size and location of the stone and whether the kidney is obstructed. Intravenous medication treats the pain and the nausea, intravenous fluids address dehydration from vomiting, and anti-inflammatory medication reduces the swelling in the ureter that is part of why it hurts. Most stones, particularly small ones, pass on their own over days to weeks, and the medication to manage that at home is written as a prescription for you to fill at your own pharmacy.

Some situations need more than an emergency room can provide. A stone too large to pass needs a urologic procedure: shock wave lithotripsy, ureteroscopy or a stent, and those are performed by a urologist in a hospital or surgical center, not at a freestanding emergency room. An infected, obstructed kidney is the genuine emergency in this condition: pressure and infection together can progress to sepsis, and the kidney needs draining urgently. Intractable pain or vomiting, significant kidney injury, or stone disease in someone with a single working kidney or a transplanted kidney also needs inpatient care.

In all of those, treatment begins here. Antibiotics, fluids, pain control and the imaging the receiving urologist needs are all started during this visit, and care continues without interruption on transfer to a hospital with the service required. Transfer when a procedure is needed is the normal course of this condition, not a shortfall in the visit, the diagnosis that makes the transfer the right call is itself the work.

Children

Bellaire ER treats adults and children. Kidney stones in children are far less common than in adults but not rare, and the presentation is frequently atypical: instead of the classic waves of flank pain radiating to the groin, a child may have vague abdominal pain, vomiting, or simply blood in the urine found on a test done for another reason. A younger child may not be able to localize the pain at all.

Because stones are uncommon at that age, a child with a stone is investigated differently afterward. Children who form stones are more likely to have an underlying metabolic or anatomical reason: a problem with how the kidneys handle calcium or other minerals, a urinary tract abnormality, or a genetic condition, and they are referred to pediatric urology or nephrology for that reason rather than simply treated and discharged. The follow-up is the point, not an optional extra.

Imaging in children is deliberately different. Ultrasound comes first because it carries no radiation, and CT is used only when ultrasound cannot answer the question, so that the radiation dose is limited to what is genuinely necessary. Laboratory testing, including urinalysis and kidney function, is done on site.

Bring a child in urgently for fever alongside flank or abdominal pain, which raises the possibility of an infected and obstructed kidney; for visible blood in the urine; for vomiting that stops them keeping fluids down; or for pain severe enough that they cannot settle. Any infant under three months with a rectal temperature of 100.4 degrees Fahrenheit or higher needs emergency evaluation regardless of the rest of the picture.

After you leave

If your stone is expected to pass on its own, the next days to weeks are a waiting period with a plan rather than a cure. Drink enough water to keep your urine pale, stay reasonably active rather than lying still, and take the medication you were given on the schedule you were given rather than waiting for the pain to peak. Some stones pass within days; larger ones can take weeks. A second wave of pain as the stone moves is expected and is not in itself a sign that something has gone wrong.

You were probably asked to strain your urine to catch the stone. It is worth doing: knowing the composition tells a urologist what kind of stone you form and what will reduce the chance of the next one. Keep it, even if it looks like nothing much.

Come back, or come in now if you cannot travel safely, if you develop a fever or shaking chills, that combination with a stone is the one that cannot wait until morning. Return if the pain becomes unmanageable despite your medication, if you are vomiting and cannot keep fluids or tablets down, if you stop urinating or pass markedly less than usual, or if you see heavy bleeding or clots in your urine. Anyone with one working kidney, a transplanted kidney, pregnancy, diabetes or a weakened immune system should come back at a lower threshold than this.

Keep the urology follow-up you were given, even if the stone passes and the pain resolves, particularly if imaging showed a second stone still sitting in the kidney. Having formed one stone raises the chance of forming another, and that appointment is where the prevention plan gets made. Bring your discharge paperwork and your CT result with you so the imaging does not need repeating.

Lowering your risk

Drinking enough water throughout the day is the single most effective way to prevent kidney stones, because dilute urine makes it harder for crystals to form. Depending on the type of stone you have formed before, your doctor may also recommend limiting sodium, moderating animal protein, or adjusting how you get calcium and oxalate in your diet, and certain medications can help prevent recurrence. If you have had a stone once, you are at higher risk of another, so it is worth reviewing a prevention plan with your doctor or urologist.