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Kidney stones are hard crystals that form when minerals in the urine become too concentrated. About 8 in 10 are calcium oxalate or calcium phosphate; the rest are uric acid, infection-related struvite, or rarely cystine. A stone sitting in the kidney may cause nothing. Pain starts when it moves into the ureter, the narrow tube to the bladder, and blocks the flow of urine.

Around 1 in 10 people will have a stone in their lifetime, and without preventive measures about half will form another within 5 to 10 years. Whether a stone will pass depends mainly on its size and position: most under 5 mm pass by themselves, while those over 10 mm rarely do.

Symptoms

• Sudden severe pain in the side or back that comes in waves and may move to the groin or testicle
• Restlessness, being unable to find a comfortable position
• Nausea and vomiting
• Blood in the urine, visible or microscopic
• Burning, urgency and frequent urination as the stone nears the bladder
• Fever and chills if infection develops behind the blockage
• No symptoms, with the stone found incidentally on a scan

Causes and risk factors

Not drinking enough is the commonest cause, which is why stones are more frequent in hot climates and hot workplaces. Diets high in salt, animal protein and sugar-sweetened drinks raise urinary calcium and uric acid. Obesity, diabetes and gout favour uric acid stones. Medical causes include overactive parathyroid glands, inflammatory bowel disease and gastric bypass, which increase oxalate absorption, renal tubular acidosis, recurrent infection with urea-splitting bacteria, and cystinuria. Family history, anatomical variants such as horseshoe kidney, and medicines including topiramate, high dose vitamin C and excess calcium with vitamin D also contribute.

How it is diagnosed

• Non-contrast low dose CT: The most accurate test. It shows stone size, position and density, which predicts how well shock waves will work.
• Ultrasound: First choice in pregnancy, in children and for follow-up. It shows kidney swelling but misses many ureteric stones.
• Urinalysis and culture: Detect blood and infection; urine pH gives a clue to stone type.
• Blood tests: Kidney function, calcium, uric acid and inflammatory markers.
• Stone analysis: Sieve your urine and keep any stone for laboratory analysis.
• 24 hour urine collection: Recommended for recurrent stone formers to measure volume, calcium, oxalate, citrate, uric acid and sodium.

Treatment options

• Pain relief and allowing passage: Anti-inflammatory painkillers are most effective for colic. An alpha blocker such as tamsulosin can aid passage of lower ureteric stones of 5 to 10 mm. Up to 4 to 6 weeks is allowed if pain is controlled and there is no infection.
• Shock wave lithotripsy (ESWL): Focused shock waves from outside the body break stones of up to about 2 cm in the kidney or upper ureter. No incisions; more than one session may be needed.
• Ureteroscopy and flexible RIRS: A thin scope through the urethra with a holmium or thulium laser to fragment and remove stones. A temporary stent is often left for days to weeks.
• Percutaneous nephrolithotomy (PCNL): Keyhole access through the back for stones over 2 cm or staghorn stones, with 1 to 3 nights in hospital.
• Urgent drainage: A stent or a nephrostomy tube to relieve an infected, blocked kidney before the stone is dealt with.
• Dissolution therapy: Potassium citrate or sodium bicarbonate to raise urine pH can dissolve uric acid stones.
• Prevention: Drink enough to pass 2 to 2.5 litres of urine daily, cut salt, moderate animal protein, keep normal dietary calcium, and use thiazides, citrate or allopurinol according to urine results.

When it is urgent

Fever or shivering with stone pain means a possibly infected, blocked kidney and needs emergency drainage locally the same day. Also go to an emergency department if pain or vomiting cannot be controlled, if you pass no urine, or if you have only one working kidney. Do not get on a plane with an obstructing stone.

Travelling to Türkiye for treatment

A known stone that is not causing obstruction or infection can be treated on a planned visit. Send your CT so the urologist can recommend ESWL, ureteroscopy or PCNL. Allow about 4 to 6 days for ureteroscopy and 7 to 10 days for PCNL. Agree in advance who will remove any stent: before you leave, by your local urologist, or by a string you pull yourself. A forgotten stent causes serious harm. Metabolic testing and prevention are best overseen at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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