Kidney stones are small, hardened deposits that form within the kidneys. These formations can remain asymptomatic for extended periods, yet when they begin to move through the narrow urinary tract, they often cause sudden, intense pain known as renal colic. This severe discomfort often prompts individuals to seek immediate medical attention. While some smaller stones may pass on their own, others necessitate emergency care to manage symptoms and prevent complications.
When to Seek Emergency Care
Sudden, excruciating pain in the back, side, or lower abdomen is a primary indicator for seeking emergency care for kidney stones. This pain often radiates to the groin and typically comes in waves, intensifying and subsiding as the stone moves through the ureter. The discomfort can be so profound that it becomes unbearable, and over-the-counter pain medications offer no relief.
Other symptoms warranting an ER visit include the presence of a fever, especially if it exceeds 101.5 degrees Fahrenheit, accompanied by chills. These signs can point to a urinary tract infection, which, when combined with a kidney stone, can lead to serious complications like sepsis. Nausea and vomiting are also common alongside severe pain, and if these symptoms prevent fluid intake, dehydration can worsen the situation. Any difficulty urinating, a burning sensation during urination, or the inability to pass urine at all suggests a potential blockage that requires prompt evaluation. Blood in the urine also signals the need for medical assessment.
ER Diagnosis and Initial Management
Upon arrival at the emergency room, healthcare professionals prioritize confirming the presence of a kidney stone and assessing its characteristics. Imaging tests are central to this process, with a non-contrast computed tomography (CT) scan being the most common and effective method for identifying stones, determining their size, and pinpointing their exact location within the urinary tract. CT scans offer quick and precise diagnoses, making them particularly suitable for emergency settings. Alternatively, an ultrasound may be used, particularly for pregnant women or children, to visualize the kidneys, ureters, and bladder and check for stones or signs of obstruction.
In addition to imaging, urine tests are conducted to check for infection, blood, or crystals that contribute to stone formation. A urinalysis can reveal the presence of red or white blood cells and bacteria, indicating a potential urinary tract infection. Blood tests are also performed to evaluate kidney function and to check for elevated levels of substances like calcium or uric acid, which are common components of kidney stones.
Once a kidney stone is confirmed, the immediate focus shifts to managing the patient’s symptoms. Pain relief is a top priority, often achieved through intravenous (IV) administration of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ketorolac, or stronger opioid analgesics for severe, unmanageable pain. Anti-nausea medications are also given intravenously to alleviate vomiting and allow for better hydration. Intravenous fluids are administered to correct dehydration and help promote urine flow, which can aid in the stone’s passage.
ER Treatment Approaches for Kidney Stones
After initial stabilization, the emergency room focuses on interventions to address the kidney stone itself. For smaller stones, generally those less than 10 millimeters, medical expulsion therapy (MET) is a common approach. This involves prescribing medications like alpha-blockers, such as tamsulosin (Flomax), which work by relaxing the muscles in the ureter, the tube connecting the kidney to the bladder. This relaxation can widen the ureter, making it easier for the stone to pass through the urinary tract and into the bladder. Alpha-blockers can significantly improve the stone expulsion rate, particularly for stones located in the distal (lower) part of the ureter.
While the ER can initiate MET, definitive stone removal procedures are typically performed by a urologist in an outpatient setting or during a subsequent hospital admission. The ER plays a significant role in assessing the need for such interventions and preparing the patient. For instance, if the stone is too large to pass naturally (typically greater than 10 mm), or if there are signs of severe infection, acute kidney injury, or uncontrolled pain, the ER physician will arrange for admission to the hospital. In cases where both obstruction and infection are present, emergency decompression of the upper urinary collecting system, often through the placement of a ureteral stent or a percutaneous nephrostomy tube, is performed to drain urine and relieve pressure. This aims to prevent further kidney damage and systemic infection.
After the ER Visit
Following an ER visit for kidney stones, patients receive specific at-home care instructions to facilitate stone passage and symptom management. This usually includes advice to increase fluid intake, with a recommendation to drink enough water to produce clear or nearly clear urine, typically 2.5 to 3 liters per day. Patients are often discharged with prescriptions for pain relievers, which may include NSAIDs or stronger analgesics, and sometimes anti-nausea medications.
The ER staff will also emphasize the importance of straining urine to collect any passed stones. This stone can then be analyzed to determine its chemical composition, which helps healthcare providers understand the cause of the stone and develop strategies to prevent future occurrences. Scheduling follow-up appointments with a urologist or primary care physician is also a standard part of post-ER care. These follow-up visits allow for monitoring of the stone’s progress, assessment of kidney function, and discussion of long-term preventative measures, which may include dietary modifications or further medical management.