Kidney Stones (Nephrolithiasis): Symptoms, Complaints, Signs

The following symptoms and complaints may indicate nephrolithiasis (kidney stones):

Leading symptoms of renal colic

  • Contraction-like or cramping mid-abdominal and/or low back pain (renal colic; ureteral colic/ureteral colic) (up to annihilation pain).
  • Nausea (nausea)
  • Vomiting
  • Hematuria (blood in the urine): microhematuria and macrohematuria (microhematuria: no discoloration of the urine; only in the microscopic image erythrocytes (red blood cells) are noticeable; macrohematuria: red coloration of the urine) [Note: absence of hematuria does not exclude acute nephrolithiasis (about 10% of cases)].

Concomitant symptoms (when passing through narrowing sites):

  • Meteorism (bloated abdomen)
  • Bradycardia – too slow heartbeat: < 60 beats per minute.
  • Collapse
  • Dysuria (pain during urination)
  • Urinary dysfunction
  • Pollakisuria (urge to urinate frequently without increased urination).
  • Acute flank pain (severe wave-like pain) radiating to:
    • Inguinal region (groin)
    • Testis
    • Penis
    • Labia (labia)
  • Abdominal wall tension (very rare)
  • Constipation (constipation)
  • Restlessness

Urinary stones in children see below.

Pain radiation depending on the location of the stone

Stone localization Pain radiation
Renal pelvic calices + upper third of ureter Middle abdomen + back
Middle third of urethra Groin + inner thigh
Distal (lower) third of ureter Testis or labia (labia majora)

Kidney stones behave asymptomatically when they lie quietly in the kidney. Only when they pass through constrictions can colic occur.

STONE score

The presence or absence of ureteral (ureteral) stones in patients with acute flank pain can be predicted with high reliability using the STONE score. This new score is intended to complement sonography (ultrasound). A computer tomography can be avoided if necessary due to the positive score result (see below). The following parameters are recorded:

  • Gender
  • Pain onset
  • Nausea (nausea)/vomiting
  • Hematuria (blood in the urine)
  • Skin color
Parameter Points
Gender
Female 0
Male 2
Pain onset
> 24 h 0
6-24 h 1
< 6 h 3
Nausea
None 0
Nausea 1
Vomit 2
Hematuria
No 0
Yes 3
Skin color
Black 0
White 3
Total 0-13

The scale ranges from 0 to 13 points, and the classification is made into three groups:

  • 0-5 points – low risk
  • 6-9 points – medium risk
  • ≥ 10 points – high risk

Urinary stones in children

  • Approximately one percent of all cases of urolithiasis involve children under 18 years of age.
  • Stone events affect girls and boys with equal frequency.
  • The pathophysiological processes of stone formation correspond to those of adults.
  • Genetic causes and infection-associated stone formation are more common in children than in adults.
  • Children are among the high-risk stone patients.
  • Hereditary (genetic) causes (eg, hyperoxaluria, cystinuria) and congenital anatomic causes are more common. Therefore, extended metabolic diagnosis should be performed in all children with urolithiasis!
  • Spontaneous ureteral stehe ein are more likely in children than in adults.

The following symptoms and complaints may indicate urolithiasis (urinary stones) in children:

  • Younger children:
  • Older children and adolescents (analogous to adults):
    • Flank pain
    • Macro- or microhematuria

    In many children, the only clues are just microhematuria or a urinary tract infection!