Tag Archive for: ureteric calculi

Hydronephrosis and Urinary Stones in Pregnancy What expectant mothers should know about flank pain, infection, premature labour and safe imaging

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Pregnancy changes the urinary tract. The kidneys filter more blood, the hormone progesterone relaxes the ureters, and the enlarging uterus can compress them. As a result, the kidney drainage system and ureters often become dilated, a finding called hydronephrosis or hydroureter.

In most women this is a normal, temporary effect of pregnancy. However, hydronephrosis can also be caused by a kidney or ureteric stone, infection or, less commonly, another obstruction. The challenge is deciding whether the dilatation is physiological or whether the kidney is genuinely blocked and needs treatment.

Seek urgent medical assessment for flank pain accompanied by fever, chills, feeling faint or very unwell, persistent vomiting, difficulty passing urine, reduced fetal movement, contractions, vaginal bleeding or fluid loss. An infected, obstructed kidney is a urological emergency.

Why does hydronephrosis occur during pregnancy?

Physiological hydronephrosis usually develops during the second trimester, becomes most marked around 24–28 weeks and is often greater on the right. It results from:

  • progesterone-related relaxation of ureteric smooth muscle;
  • compression of the ureters by the growing uterus at the pelvic brim;
  • rotation of the uterus, which tends to place more pressure on the right ureter; and
  • increased urine production during pregnancy.

This dilatation commonly settles within several weeks after delivery. Physiological hydronephrosis is not itself a stone and does not automatically require a stent or operation.

Features that make pathological obstruction more likely include severe colicky flank pain, blood in the urine, a visible stone, dilatation extending below the pelvic brim, an absent or reduced ureteric jet on the symptomatic side, impaired kidney function, infection or worsening hydronephrosis. No single ultrasound sign is perfect; the symptoms, blood and urine tests, imaging and obstetric assessment must be considered together.

Kidney and ureteric calculi in pregnancy

Urinary calculi are stones located in the kidney or ureter. They are an important cause of non-obstetric abdominal or flank pain during pregnancy and occur most often in the second or third trimester. Typical symptoms include:

  • sudden pain in the loin, flank, abdomen or groin, which may come in waves;
  • nausea and vomiting;
  • visible or microscopic blood in the urine;
  • urinary frequency, urgency or burning; and
  • fever or rigors if infection is present.

Pregnancy increases urinary calcium and urate excretion, while other natural protective factors also rise. For this reason, pregnancy does not necessarily increase the overall number of stones, although the stone pattern may differ and calcium-phosphate stones are relatively more common.

Why infection matters

Pregnancy-related ureteric dilatation and slower urinary drainage encourage urinary stasis. A stone can worsen this by partly or completely blocking the ureter. Bacteria trapped above an obstruction may cause pyelonephritis, pyonephrosis, bacteraemia or sepsis.

All women with suspected renal colic should therefore have urinalysis and a urine culture. Blood tests commonly include a full blood count, kidney function, electrolytes and inflammatory markers. Antibiotics are selected according to pregnancy safety, local resistance patterns and culture results.

Antibiotics alone are not sufficient when infection is trapped behind an obstructed kidney. Urgent decompression with a ureteric stent or percutaneous nephrostomy is required, together with intravenous antibiotics and coordinated obstetric care. Definitive stone treatment is usually delayed until sepsis has resolved.

Is there a risk of premature labour?

Observational studies associate symptomatic stones and renal obstruction in pregnancy with higher rates of urinary infection, hospital admission, preterm contractions and preterm delivery. Severe pain, dehydration, inflammation and infection may all contribute. However, the absolute risk for an individual woman varies, and an association does not mean that every renal colic episode will trigger premature labour.

The condition requiring intervention may itself be responsible for some of the reported risk. For this reason, treatment decisions should not be based on procedure statistics alone. The balance is between allowing a stable stone time to pass and promptly treating uncontrolled pain, infection or threatened kidney function. Depending on gestational age and clinical circumstances, fetal monitoring and assessment for contractions may be appropriate.

How is it investigated?

1. Ultrasound first

Renal and bladder ultrasound is the preferred first-line test because it uses sound waves rather than ionising radiation. It can show hydronephrosis, some kidney or ureteric stones, ureteric jets and alternative diagnoses. Transvaginal ultrasound may help identify a distal ureteric stone.

Ultrasound has limitations: physiological hydronephrosis can resemble obstruction, and a small ureteric stone may not be visible. A normal or inconclusive scan does not always exclude a stone.

2. MRI or MR urography when uncertainty remains

MRI without gadolinium can identify the level and pattern of obstruction without ionising radiation. Stones usually appear as signal voids rather than being seen as clearly as on CT. MRI is therefore a useful second-line test, particularly when ultrasound is inconclusive and the patient is clinically stable. Gadolinium contrast is not routinely used during pregnancy.

3. Low-dose non-contrast CT only when clinically necessary

Low-dose CT is the most accurate test for a urinary stone, but it uses ionising radiation. European Association of Urology guidance places low-dose CT as a last-line option in pregnancy, after ultrasound and usually MRI, when diagnostic uncertainty could change urgent management.

The practical radiation principles are:

  • use imaging only when it will answer an important clinical question;
  • prefer ultrasound, followed by MRI without contrast, when suitable;
  • if CT is necessary, use a pregnancy-adapted low-dose protocol and limit the scanned area;
  • avoid repeated or multiphase CT examinations unless clearly justified; and
  • involve an experienced radiologist and document the risk–benefit discussion.

Diagnostic imaging should not be withheld when delay or uncertainty poses a greater risk to the mother or baby. The EAU notes that deterministic fetal effects require substantially higher exposure than most diagnostic studies and considers doses below 50 mGy safe in this context; nevertheless, any ionising-radiation examination must be justified and kept as low as reasonably achievable. Ultrasound and MRI do not use ionising radiation.

Management options

Treatment is individualised by symptoms, infection status, stone size and location, kidney function, gestational age, obstetric factors and local expertise. Close collaboration between urology, obstetrics, radiology, anaesthesia and neonatology may be needed.

Conservative management

Most uncomplicated cases are initially managed without surgery. This may include:

  • oral or intravenous fluids sufficient to correct dehydration, forced overhydration does not “flush out” a stone;
  • anti-nausea medication;
  • analgesia suitable for the stage of pregnancy;
  • urine culture and pregnancy-compatible antibiotics when infection is confirmed; and
  • follow-up to ensure symptoms resolve and kidney drainage and function remain satisfactory.

Paracetamol is commonly used first-line. Opioids may be used for severe pain under medical supervision. Non-steroidal anti-inflammatory drugs such as ibuprofen and diclofenac should not be self-administered in pregnancy; their fetal renal, amniotic-fluid and ductus arteriosus risks depend on gestation, dose and duration. The evidence for medical expulsive therapy with alpha-blockers during pregnancy is limited, and such treatment should only be considered after specialist discussion.

Conservative treatment is unsuitable when there is sepsis, deteriorating kidney function, a solitary obstructed kidney, bilateral obstruction, persistent vomiting, uncontrolled pain, severe or progressive hydronephrosis, renal forniceal rupture, threatened premature labour or failure of the stone to pass with ongoing clinically important obstruction.

Ureteric stent

A JJ stent bypasses the obstruction and drains urine from the kidney to the bladder. It can be inserted with minimal or no fluoroscopy, using ultrasound guidance where appropriate. Stents can cause urinary frequency, urgency, discomfort, blood in the urine, infection and encrustation. Encrustation develops faster in pregnancy, so regular review and sometimes exchange every 4–6 weeks are required. A stent must not be forgotten after delivery.

Percutaneous nephrostomy

A nephrostomy tube drains the kidney through the back and can often be placed with ultrasound guidance. It is particularly useful when retrograde stenting is not possible or when urgent drainage is required in selected circumstances. Disadvantages include an external bag, discomfort, blockage, displacement, infection and rapid encrustation, with possible repeat exchanges.

Ureteroscopy and laser treatment

Ureteroscopy allows a surgeon to pass a fine telescope through the bladder into the ureter, remove the stone or fragment it with a laser, often without fluoroscopy. It provides definitive treatment and avoids prolonged drainage in selected patients. If a non-urgent procedure is required, the second trimester is generally preferred, and it should be performed by an experienced team with obstetric and neonatal support available. Ureteroscopy is not the first step in an untreated septic obstruction; drainage and infection control come first.

Treatments generally avoided

Shock-wave lithotripsy is contraindicated during pregnancy. Percutaneous stone removal is rarely required and is reserved for carefully selected cases in highly experienced centres. Routine definitive treatment can often wait until after delivery when symptoms and kidney function permit.

After delivery

Follow-up should confirm that hydronephrosis has resolved, any stent or nephrostomy has been removed, the stone has passed or been treated, and kidney function is normal. A retrieved stone should be analysed. Women with recurrent stones, a strong family history, infection stones or other risk factors may benefit from a metabolic evaluation after pregnancy, when physiology and diet have stabilised.

The important message

Most hydronephrosis in pregnancy is physiological, and many stones pass with careful conservative management. The dangerous combination is obstruction plus infection. Fever, rigors or systemic illness with flank pain requires urgent assessment because prompt antibiotics and drainage can protect the mother, kidney and pregnancy. Imaging should follow a stepwise approach, ultrasound first, MRI second and low-dose CT only when the clinical benefit justifies it.

References

  1. European Association of Urology. EAU Guidelines on Urolithiasis: Diagnostic imaging during pregnancy; management of urinary stones during pregnancy. Current online guideline. https://uroweb.org/guidelines/urolithiasis/chapter/guidelines
  2. Lee MS, Fenstermaker MA, Naoum EE, et al. Management of nephrolithiasis in pregnancy: multi-disciplinary guidelines from an academic medical center. Front Surg. 2021;8:796876. https://doi.org/10.3389/fsurg.2021.796876
  3. Chan K, Shakir T, El-Taji O, et al. Management of urolithiasis in pregnancy. Curr Urol. 2023;17(1):1–6. https://doi.org/10.1097/CU9.0000000000000181
  4. American College of Obstetricians and Gynecologists. Guidelines for diagnostic imaging during pregnancy and lactation. Committee Opinion No. 723. Obstet Gynecol. 2017;130–e216. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation
  5. Drescher M, Blackwell RH, Patel PM, et al. Antepartum nephrolithiasis and the risk of preterm delivery. Urolithiasis. 2019;47:441–448. https://doi.org/10.1007/s00240-018-1085-3

This information is general education and does not replace individual medical or obstetric advice. Medication and imaging decisions in pregnancy should be made with the treating obstetric, urology and radiology teams.

Kidney Stones: Understanding the Different Types of Renal Calculi and Their Treatment

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Kidney stones, medically known as renal calculi or nephrolithiasis, are solid crystalline deposits that develop within the kidneys. Although we tend to talk about “a kidney stone” as if all stones are the same, there are several distinctly different types.

Knowing the composition of a kidney stone matters. Different stones have different causes, appearances, recurrence risks and, importantly, different strategies for prevention and treatment.

Modern management therefore involves more than simply removing the stone. The aim is to answer three questions:

What is the stone? Why did it form? And how can we prevent the next one?

What Are Kidney Stones Made Of?

The major types of urinary stones are:

  1. Calcium oxalate stones
  2. Calcium phosphate stones
  3. Uric acid stones
  4. Struvite or infection stones
  5. Cystine stones
  6. Rare metabolic and medication-related stones

Stones are not always chemically pure. Many contain a mixture of different crystalline components.

The European Association of Urology recommends reliable stone analysis and a basic metabolic evaluation in stone-forming patients, with more detailed metabolic investigation particularly important in patients at high risk of recurrence.

1. Calcium Oxalate Stones

The most common kidney stone

Calcium oxalate stones are the most frequently encountered urinary calculi.

They may consist predominantly of:

  • Calcium oxalate monohydrate, known as whewellite
  • Calcium oxalate dihydrate, known as weddellite

Calcium oxalate monohydrate stones can be particularly hard and resistant to fragmentation with shockwave lithotripsy.

Why do calcium oxalate stones form?

Contributing factors may include:

  • Low urine volume or dehydration
  • Excess urinary calcium
  • Excess urinary oxalate
  • Low urinary citrate
  • High dietary sodium intake
  • Excessive animal protein intake
  • Certain bowel diseases or previous intestinal surgery
  • Genetic predisposition
  • Metabolic abnormalities

Importantly, calcium stones do not necessarily mean that a patient is eating too much calcium.

Severely restricting normal dietary calcium can actually be counterproductive because calcium within the intestine binds oxalate and reduces its absorption.

Management

Small asymptomatic stones may sometimes simply be monitored.

When treatment is required, options include:

  • Shockwave lithotripsy (SWL)
  • Flexible ureteroscopy and laser lithotripsy
  • Percutaneous nephrolithotomy (PCNL)
  • Observation in appropriately selected patients

Prevention depends on the underlying metabolic abnormality and may include increased fluid intake, dietary modification, reduction in excessive sodium intake, potassium citrate for selected patients, thiazide therapy for hypercalciuria and treatment of hyperoxaluria or hyperuricosuria when identified.

2. Calcium Phosphate Stones

Calcium phosphate stones are less common than calcium oxalate stones.

They may contain:

  • Hydroxyapatite
  • Carbonate apatite
  • Brushite

Why do they form?

Calcium phosphate crystallisation is favoured by relatively alkaline urine.

They may be associated with:

  • Hypercalciuria
  • Renal tubular acidosis
  • Hyperparathyroidism
  • Urinary tract abnormalities
  • Certain metabolic disorders

Brushite stones deserve particular attention. They can be extremely hard and may respond poorly to shockwave treatment.

Management therefore needs to consider not only stone size and location, but also stone density and previous stone composition.

3. Uric Acid Stones

Uric acid stones behave very differently from calcium stones.

They are strongly associated with persistently acidic urine and may occur in patients with:

  • Gout
  • Metabolic syndrome
  • Diabetes
  • Obesity
  • High purine intake
  • High animal-protein intake
  • Chronic dehydration
  • Excessive uric acid production or excretion

Uric acid stones account for approximately 10% of renal stones and all uric acid stone formers are considered at increased risk of recurrence.

Why are uric acid stones special?

Because unlike most kidney stones, uric acid stones can potentially be dissolved.

Treatment involves increasing urinary pH, usually using an alkalinising medication such as potassium citrate.

For active oral dissolution therapy, urinary pH needs to be carefully monitored. Current EAU guidance describes targeting approximately pH 7.0–7.2 during chemolysis, while avoiding excessive alkalinisation because this may encourage calcium phosphate crystallisation.

This creates one of the happier conversations in stone management:

“You have a kidney stone, but we may be able to make it disappear without an operation.”

Not every uric acid stone will dissolve successfully, and obstructed or infected kidneys require separate and sometimes urgent treatment.

4. Struvite Stones: The Infection Stones

Struvite stones contain magnesium ammonium phosphate and are closely associated with urinary infections caused by certain urease-producing bacteria.

These bacteria change the chemistry of the urine, producing an alkaline environment favourable for rapid stone formation.

Struvite stones can become very large and occasionally form a branching staghorn calculus, occupying much of the kidney’s collecting system.

Why are these stones important?

The stone and infection can maintain one another.

Leaving significant infected stone material behind may therefore contribute to:

  • Recurrent urinary infection
  • Rapid stone regrowth
  • Kidney damage
  • Sepsis

Management generally involves treating the infection and achieving as complete a stone clearance as reasonably possible. Large stones frequently require PCNL, sometimes performed in more than one stage.

Infection stone formers are regarded as being at high risk of recurrence.

5. Cystine Stones

Cystine stones are uncommon and are caused by cystinuria, an inherited disorder affecting the transport of certain amino acids through the kidneys.

Cystine is relatively insoluble in urine and can crystallise to form stones.

These patients may start developing stones at a young age and can experience repeated stone episodes throughout life.

Treatment and prevention

Prevention is particularly important and may involve:

  • Very high fluid intake
  • Reduced dietary sodium
  • Urinary alkalinisation
  • Potassium citrate
  • Specialist medication such as tiopronin in selected recurrent cases

Current EAU guidance recommends aiming for a urine volume greater than 3 litres per day in adults with cystinuria and maintaining urinary pH above approximately 7.5 to improve cystine solubility.

Cystine stones are also relatively hard, which can make shockwave treatment less successful. Ureteroscopy with laser treatment or PCNL may therefore be required depending on stone burden.

6. Rare Kidney Stones

Much less commonly, stones may consist of substances such as:

  • Xanthine
  • 2,8-dihydroxyadenine
  • Ammonium urate
  • Matrix material
  • Medication-related crystalline material

These stones can sometimes provide the first clue to an underlying metabolic, genetic or medication-related disorder.

Recurrent unusual stones therefore deserve specialist investigation rather than simply repeated stone removal.

How Do Kidney Stones Present?

Some kidney stones sit quietly within the kidney and are discovered incidentally during an ultrasound or CT scan.

Others announce their arrival with considerably less subtlety.

A stone entering and obstructing the ureter may cause renal colic, producing severe pain from the loin toward the abdomen or groin.

Other symptoms can include:

  • Blood in the urine
  • Nausea and vomiting
  • Urinary urgency or frequency
  • Burning during urination
  • Recurrent urinary infection
  • Fever or chills
  • Intermittent loin discomfort

Fever plus an obstructed kidney is an emergency

An infected obstructed urinary system can progress rapidly to urosepsis.

Urgent drainage with a ureteric stent or nephrostomy tube, together with appropriate antibiotics and supportive treatment, may be required. Definitive stone treatment is generally delayed until the infection has been controlled.

How Are Kidney Stones Investigated?

CT Scan

A non-contrast CT scan of the kidneys, ureters and bladder provides detailed information regarding:

  • Stone size
  • Number of stones
  • Exact location
  • Degree of obstruction
  • Kidney anatomy
  • Stone density measured in Hounsfield units

CT density may also provide clues about stone composition and the likelihood of successful shockwave fragmentation.

Ultrasound

Ultrasound avoids radiation and is particularly useful for:

  • Surveillance
  • Detecting hydronephrosis
  • Monitoring known renal stones
  • Selected younger patients
  • Pregnancy

However, very small stones and ureteric stones can sometimes be difficult to identify accurately.

Plain X-ray

A KUB X-ray may be useful for monitoring certain radiopaque stones.

Calcium-containing stones are usually radiopaque, whereas uric acid stones are typically radiolucent on plain X-ray.

Do All Kidney Stones Need Treatment?

No.

A small, non-obstructing and asymptomatic kidney stone may sometimes be monitored with periodic imaging.

Treatment becomes more appropriate when there is:

  • Stone growth
  • Recurrent pain
  • Haematuria
  • Urinary obstruction
  • Recurrent infection
  • Declining renal function
  • Significant stone burden
  • High risk of future complications
  • Occupational or travel considerations
  • Patient preference

These factors are reflected in contemporary EAU recommendations.

Treatment Options for Kidney Stones

1. Active Surveillance

Small asymptomatic renal stones can sometimes be observed.

Follow-up may include ultrasound, X-ray or CT depending on the type, size and visibility of the stone.

The advantage is obvious: no procedure unless one becomes necessary.

The disadvantage is equally obvious: stones have not signed a contract promising to remain where they are.

They may enlarge, migrate into the ureter, cause obstruction or become symptomatic.

2. Shockwave Lithotripsy

Extracorporeal shockwave lithotripsy (SWL) uses externally generated shockwaves focused onto the stone.

The aim is to fragment the calculus into smaller pieces that can subsequently pass through the urinary tract.

Advantages

  • Non-invasive
  • Usually rapid recovery
  • No incision
  • Useful for appropriately selected renal stones

Limitations

Success depends on:

  • Stone size
  • Location
  • Density
  • Composition
  • Skin-to-stone distance
  • Renal anatomy

Hard stones such as calcium oxalate monohydrate, brushite and cystine stones may be less responsive.

More than one treatment session may be required.

3. Flexible Ureteroscopy and Laser Lithotripsy

A fine flexible telescope is passed through the urethra and bladder, up the ureter and into the kidney.

There are no external incisions.

The stone can then be fragmented or dusted using a laser, with larger fragments removed using tiny retrieval baskets.

Advantages

  • Minimally invasive
  • High stone clearance rates for appropriately selected stones
  • Can treat stones resistant to shockwave therapy
  • Allows direct visualisation
  • Suitable for many locations within the kidney

Possible disadvantages

  • Requires anaesthesia
  • Temporary ureteric stenting may be required
  • Stent discomfort
  • Bleeding or infection
  • Ureteric injury is uncommon but possible
  • Occasionally a second procedure is required

4. Percutaneous Nephrolithotomy

PCNL involves creating a small tract through the skin directly into the kidney.

It is particularly useful for:

  • Large renal calculi
  • Staghorn stones
  • Complex stones
  • Large-volume infection stones
  • Stones unlikely to respond adequately to less invasive techniques

Current EAU guidance recommends PCNL as the first-line treatment for renal stones larger than 2 cm in most suitable patients.

PCNL generally provides excellent clearance of large stone burdens but is more invasive than ureteroscopy or shockwave treatment.

Potential complications include bleeding, infection, injury to surrounding structures and the need for additional procedures.

5. Dissolution Therapy

This option is mainly relevant to uric acid stones.

Urinary alkalinisation can gradually dissolve the stone, potentially avoiding surgery.

Treatment requires:

  • Correct identification or strong suspicion of uric acid composition
  • Regular urine pH monitoring
  • Appropriate alkalinising medication
  • Follow-up imaging
  • Patient compliance

It is important not to assume that every radiolucent stone is uric acid, and treatment should be supervised appropriately.

Choosing the Right Treatment

There is no single “best” kidney stone operation.

The appropriate treatment depends on a combination of:

Stone factors

  • Size
  • Number
  • Location
  • Composition
  • Density
  • Previous growth

Kidney factors

  • Anatomy
  • Obstruction
  • Infection
  • Renal function

Patient factors

  • Symptoms
  • Medical conditions
  • Anticoagulant therapy
  • Previous stone procedures
  • Occupation
  • Travel requirements
  • Personal preference

Two patients with apparently similar 10 mm stones may therefore receive quite different recommendations.

Preventing the Next Kidney Stone

Removing a stone solves today’s problem.

Preventing another stone solves tomorrow’s problem.

Patients with recurrent stones, multiple stones, bilateral stones, unusual stone composition, young age at presentation or other high-risk features may benefit from metabolic investigation.

This may include blood testing and 24-hour urine collections assessing factors such as:

  • Urine volume
  • Calcium
  • Oxalate
  • Citrate
  • Uric acid
  • Sodium
  • Magnesium
  • Urinary pH

Stone analysis is particularly valuable whenever a stone can be retrieved. Current EAU guidance recommends reliable stone analysis and basic metabolic evaluation for stone formers, with specific metabolic assessment for high-risk patients.

General Kidney Stone Prevention

Although prevention should ultimately be tailored to stone composition, several principles apply to many stone formers.

Drink more water

Maintaining generous urine output dilutes the substances responsible for crystal formation.

Water remains wonderfully unexciting and remarkably effective.

Reduce excessive salt intake

High sodium intake can increase urinary calcium excretion and contribute to calcium stone formation.

Maintain normal dietary calcium

Patients with calcium stones should not automatically eliminate calcium-containing foods.

A balanced dietary calcium intake may actually reduce intestinal oxalate absorption.

Moderate excessive animal protein

Large amounts of meat and other purine-rich foods may contribute to increased urinary uric acid and more acidic urine in susceptible individuals.

Maintain a healthy weight

Obesity and metabolic syndrome are particularly associated with uric acid stone formation.

Investigate recurrent stones

Repeatedly removing stones without investigating why they keep forming can become a rather expensive game of geological whack-a-mole.

Can Medication Prevent Kidney Stones?

Yes, in appropriately selected patients.

Depending on the metabolic abnormality and stone composition, preventive medication may include:

  • Potassium citrate
  • Thiazide or thiazide-like medication
  • Allopurinol
  • Urinary alkalinising therapy
  • Tiopronin for selected cystinuria patients

Medication should ideally be guided by stone analysis, blood investigations and, when indicated, 24-hour urine testing rather than prescribed indiscriminately.

The Bottom Line

A kidney stone is not simply a kidney stone.

A calcium oxalate stone, uric acid stone, infection stone and cystine stone may look similar on a scan, but they can have very different causes and require very different long-term strategies.

Modern kidney stone management combines:

accurate imaging + appropriate stone removal + stone analysis + metabolic investigation + prevention.

Treatment may range from simple surveillance through to shockwave lithotripsy, flexible ureteroscopy and laser treatment, PCNL or, in selected uric acid stones, medical dissolution therapy.

The ultimate aim is not simply to leave the operating theatre stone-free.

It is to keep the patient stone-free.

When Should You See a Urologist?

Consider urological assessment if you have:

  • Recurrent kidney stones
  • Persistent loin or flank pain
  • Blood in the urine
  • Recurrent urinary infections
  • A stone associated with urinary obstruction
  • Increasing stone size on surveillance imaging
  • Multiple or bilateral kidney stones
  • A large renal calculus
  • Previous complex stone surgery

Severe pain associated with fever, chills or feeling systemically unwell requires urgent medical assessment, as an infected obstructed kidney can be a medical emergency.

This information is intended for general patient education and does not replace individual medical assessment. The appropriate investigation, surveillance and treatment of kidney stones should be tailored to the individual patient.

This blog is aligned with the current 2026 EAU Urolithiasis Guidelines, including the updated recommendations on stone composition, renal stone treatment and metabolic prevention.

EAU Guidelines on Urolithiasis