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Kidney Stones: Symptoms and Treatment — From Renal Colic to Surgery

Kidney stones affect nearly 1 in 11 people over a lifetime, and anyone who's already had one episode faces a notably elevated risk of another. We explain how to recognize renal colic, how the different stone types differ, when it's reasonable to just wait for a stone to pass on its own, and when lithotripsy or an endoscopic procedure becomes necessary.

MNMichał NowakSeptember 21, 202613 min read

Table of contents

TL;DR — key takeaways

→A condition that can strike with pain out of nowhere
→Types of kidney stones — they don't all form the same way
→Renal colic — how to recognize an acute episode
→Treating an acute attack — what happens right away
→When lithotripsy or surgery is needed
→Risk factors beyond hydration alone
→Diagnostics — what happens after the acute episode
→When to seek urgent care
→Kidney stones at a glance
→Our editorial recommendation

A condition that can strike with pain out of nowhere

Kidney stone disease (urolithiasis) means mineral deposits form in the urinary tract when the concentration of certain substances in the urine — most often calcium, oxalate, phosphate, or uric acid — exceeds their solubility. Stones can form silently for months, and the first sign of their existence is often the moment a deposit starts moving from the kidney into the ureter, blocking the flow of urine. That's when the characteristic, sudden renal colic appears — one of the most intense types of pain described in medicine, sometimes compared to labor pain.

Epidemiological data from the US show that kidney stones affect roughly 8.8% of the population, with men affected more often than women (about 10.6% versus 7.1%). The condition also has a notably high tendency to recur — for someone who's already had one episode, the risk of another in the following years is significantly elevated, which makes prevention just as important as treating the acute episode itself.

This article and hydration

Hydration is one of the best-documented prevention strategies for kidney stones — we cover it in detail, including the results of a classic 5-year clinical trial, in a separate article, "Hydration and Kidney Stones." Here we focus on the overall picture of the disease: symptoms, stone types, and treatment methods, including surgical ones.

Types of kidney stones — they don't all form the same way

Stone type	Share of all stones	Typical circumstances
Calcium oxalate or phosphate	~80%	The most common type; favored by high sodium intake, low fluid intake, and low dietary calcium
Uric acid	~8-10%	Strongly linked to obesity, metabolic syndrome, and type 2 diabetes; more common in men, rising after age 50
Struvite (infection stones)	~10%	Form during chronic or recurrent urinary tract infections caused by urease-producing bacteria
Cystine	~1%	Rare, genetically determined disorder of amino acid absorption (cystinuria)

Main types of kidney stones

This distinction has real clinical significance, since different stone types require different cause-focused diagnostics and different prevention strategies. Uric acid stones are especially interesting from a metabolic standpoint — their formation is strongly linked to metabolic syndrome, obesity, and insulin resistance, meaning that for some patients, controlling these factors matters for prevention beyond simply drinking more water.

Renal colic — how to recognize an acute episode

Classic renal colic is a sudden, very intense pain in the flank, often radiating downward toward the groin or lower abdomen as the stone moves along the ureter. The pain is typically wave-like and paroxysmal — intensifying and easing in cycles, unlike the constant pain typical of many other abdominal conditions. It's often accompanied by nausea, vomiting, restlessness (people with renal colic rarely find a comfortable position and tend to move around, unlike people with peritoneal pain, who try to lie still), and in many cases, visible blood in the urine (hematuria).

Myth

Blood in the urine during a colic attack means the stone is large and dangerous, while its absence means the situation is mild.

Fact

Stone size doesn't correlate directly with the presence or severity of hematuria — even a very small stone, moving and irritating the ureter's lining, can trigger visible blood in the urine, while a larger but stationary stone may cause none. Assessing a stone's size and location requires imaging (most often non-contrast CT or ultrasound), not just the presence of blood in the urine.

Treating an acute attack — what happens right away

During an acute renal colic attack, the priority is pain control — most often with nonsteroidal anti-inflammatory drugs given intravenously or intramuscularly in a hospital setting, since they not only relieve pain but also reduce swelling and spasm of the ureter around the stone. In more severe cases, opioid painkillers are used. Doctors also often add alpha-blocker medications (such as tamsulosin), which relax the smooth muscle of the ureter and make it easier for the stone to pass spontaneously — a strategy known as medical expulsive therapy.

When it's reasonable to just wait for the stone to pass

Moderate evidence

According to American Urological Association guidelines, stones up to about 10 mm in diameter located in the distal ureter have a relatively good chance of passing spontaneously, especially with the support of expulsive therapy and adequate hydration. The larger the stone, the lower the chance of spontaneous passage and the more important surgical intervention becomes.

When lithotripsy or surgery is needed

When a stone is too large to pass on its own, causes persistent obstruction, recurrent infections, or pain that doesn't respond to conservative treatment, surgical intervention becomes necessary. The American Urological Association's updated 2026 guideline describes several main methods, chosen based on the stone's size, location, and likely composition.

Main surgical treatment methods for kidney stones

Extracorporeal shock wave lithotripsy (ESWL) — a non-invasive method that breaks up the stone using shock waves generated outside the body; works well for smaller ureteral and kidney stones
Ureteroscopy (URS) with laser lithotripsy — a thin endoscope is passed through the urethra and bladder up to the ureter or kidney, where the stone is broken up with a laser (holmium or thulium) and removed; the method of choice for many ureteral stones
Percutaneous nephrolithotomy (PCNL) — recommended especially for large kidney stones (above 1-2 cm) or stones located in the hard-to-reach lower pole of the kidney; requires a small skin incision
Active surveillance — for small, asymptomatic kidney stones not causing obstruction, some patients only need regular imaging follow-up instead of immediate surgery

The choice of method isn't arbitrary

The treatment method depends on the stone's size, location, and presumed composition, the patient's urinary tract anatomy, and equipment availability at a given center. There's no single "best" method for every case — a urologist selects the optimal approach after imaging assessment.

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Risk factors beyond hydration alone

While inadequate hydration is one of the best-documented and easiest-to-modify risk factors for kidney stones, it's not the only one. Observational studies link kidney stone risk to obesity, metabolic syndrome, and type 2 diabetes — especially in the context of uric acid stones, where these factors are particularly strongly associated with risk. A large prospective cohort study combining data from three major US studies (the Health Professionals Follow-up Study and Nurses' Health Study I and II, over 240,000 participants followed for 14-18 years) found that people following a diet closest to the DASH pattern (rich in fruits, vegetables, and low-fat dairy, low in sodium) had significantly lower stone risk — 40-45% lower risk in the highest versus lowest quintile of DASH adherence, regardless of sex.

Diagnostics — what happens after the acute episode

Once the acute episode subsides, it's worth establishing the likely stone type, since prevention depends on it. If the stone passes spontaneously or is removed during a procedure, its chemical analysis is the most reliable source of this information. For people with recurrent stones, doctors often also order a 24-hour urine collection to assess excretion of calcium, oxalate, uric acid, citrate, and sodium — this test can identify specific metabolic disturbances underlying a tendency to form stones.

It's also worth remembering that recurrent urinary tract infections can be both a cause and a consequence of kidney stones — struvite stones form as a result of infection with urease-producing bacteria, while the stone itself, by blocking urine flow, promotes further infections. We cover this topic, along with separate prevention strategies, in more depth in our article on recurrent urinary tract infections in women.

When to seek urgent care

Symptoms requiring immediate consultation

Severe flank pain accompanied by fever and chills may indicate a concurrent kidney infection (pyelonephritis) — a potentially life-threatening condition requiring urgent medical attention, especially combined with ureteral obstruction from a stone. Prompt evaluation is also needed for: pain not responding to painkillers, a complete inability to urinate, severe vomiting preventing oral fluid intake, and kidney stones in someone with only one functioning kidney. This article is educational and doesn't replace medical evaluation — if you suspect renal colic, it's worth consulting a doctor or going to an emergency department, especially for a first episode.

Kidney stones at a glance

Question	Short answer
How common are they?	About 8.8% of the US population; more common in men than women
What's the most common stone type?	Calcium oxalate or phosphate — about 80% of all stones
Does every stone need surgery?	No — smaller stones (up to about 10 mm) often pass spontaneously, especially with expulsive therapy
When are lithotripsy or surgery needed?	For large stones, persistent obstruction, recurrent infections, or pain not responding to treatment
Do kidney stones recur?	Yes, recurrence risk after a first episode is significantly elevated — prevention is key

Kidney stones — the key facts

Our editorial recommendation

Kidney stone disease has two very different faces: the sudden, dramatic acute episode, and the quiet, chronic metabolic tendency that determines recurrence risk. Effective management requires both — a proper response to acute pain, and identifying and modifying the factors that favor forming more stones, from hydration through diet to controlling metabolic conditions.

Renal colic passes — sometimes on its own, sometimes after a procedure — but without understanding why a given stone formed in the first place, the risk of another episode stays high. That second part of the story is usually the one that gets skipped.

Michał Nowak, VitMode editorial team

Frequently asked questions

Not always. Small, asymptomatic kidney stones that don't cause obstruction or infection may, for some patients, qualify only for active surveillance with regular imaging follow-up instead of immediate surgery. The decision is made by a urologist based on size, location, and symptoms.

A family history of kidney stones significantly increases individual risk, suggesting a genetic component, though in most cases stone disease is multifactorial — combining genetic predisposition with diet, hydration, and metabolic conditions. Rarer forms, like cystine stones, have a clearly genetic basis.

It's more complex than it seems — low dietary calcium can paradoxically increase the risk of oxalate stones, while high-dose calcium supplements taken apart from meals have been linked to higher risk in some studies. People with a history of kidney stones should discuss calcium supplementation with a doctor rather than avoiding it entirely or taking it without guidance.

It depends on the stone's size and location — smaller stones in the distal ureter may pass within a few days to a few weeks, sometimes helped by medication that relaxes the ureter. If a stone doesn't pass after a few weeks, or is accompanied by worsening pain or infection, surgical intervention becomes necessary.

ESWL is usually performed under local anesthesia or light sedation and is generally well tolerated on its own, though afterward there can be discomfort as crushed stone fragments pass, similar to a milder version of renal colic.

No — this is a common myth. Studies show that adequate (not excessive) dietary calcium intake, including from dairy, is linked to lower, not higher, oxalate stone risk, because calcium in the digestive tract binds oxalate and limits its absorption into the bloodstream.

It's usually recommended mainly for people with recurrent stones, stones in children, a single functioning kidney, or a strong family history — not every first, uncomplicated episode requires such detailed metabolic workup. It's best to discuss this with a urologist or nephrologist.

Yes — a lower urine volume with the same amount of excreted minerals means a higher concentration of crystallizing substances, which favors stone formation. This is one reason people doing physical work in hot climates have elevated stone risk. We cover this relationship in detail in our article on hydration and kidney stones.

Sources

Michał Nowak

MSc in Clinical Dietetics, certified sports-nutrition coach

Michał started out as a long-distance runner, before an injury forced him to rethink his career. Looking for a faster way back into shape, he discovered sports nutrition and never left — fascinated by the gap between the research and what "everyone knows" at the gym. He completed a degree in clinical dietetics, earned a sports-nutrition coaching certification, and ran his own practice for several years before joining VitMode. His writing keeps returning to one theme: a supplement won't replace the basics, but the right one, at the right time, makes a real difference — and that's the difference he tries to describe precisely, with citations instead of slogans. He still runs, though these days, as he puts it, purely for the fun of it.

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