When should people to go to emergency room for kidney stones?

Kidney stones have a reputation for turning perfectly calm adults into people pacing the hallway, sweating, and swearing they’re never drinking iced tea again. Most of the time, stones are brutally painful but not life-threatening. However, there are moments when that pain is a warning sign that you need the emergency room, not just a hot shower and a water bottle.

This guide breaks down when kidney stone pain is an emergency, which symptoms you shouldn’t ignore, and when urgent care or at-home treatment makes more sense. It’s based on guidance from major medical organizations and hospitals in the United States, including Mayo Clinic, Cleveland Clinic, National Kidney Foundation, and others.

Important: This article is educational, not medical advice. If you’re in severe pain or unsure what to do, call your local emergency number (such as 911 in the U.S.) or seek immediate care.

Kidney stones 101: Why they hurt so much

A kidney stone is a hard, crystal-like deposit that forms inside your kidney from minerals and salts in your urine. Many stones are tiny and leave the body quietly, like an overachieving student who never causes trouble. Others are big, jagged, and dramatic the ones that send people to the ER.

Stones can sit in the kidney or move down the ureter (the tube from the kidney to the bladder). As they travel, they can scrape, irritate, and sometimes block the flow of urine. That blockage is what often causes the intense, wave-like pain people call renal colic.

Most small stones (often under 5 mm) can pass on their own with time, fluids, and pain control. Larger stones or stones that get stuck may require imaging, strong medication, and sometimes procedures or surgery.

Common symptoms of kidney stones

Everyone experiences pain differently, but some kidney stone symptoms are pretty classic. Common signs include:​

• Sharp pain in the side, back, or lower abdomen, often just below the ribs and usually on one side
• Pain that comes in waves and may radiate toward the lower abdomen or groin
• Pain or burning when you urinate (dysuria)
• Blood in the urine red, pink, or brown, or microscopic blood only seen on urine testing
• Needing to pee urgently or frequently
• Cloudy or foul-smelling urine
• Nausea and vomiting, especially during painful spasms

These symptoms alone don’t always mean you need an emergency room visit. The key is how severe they are and what else is happening with your body.

Red flag symptoms: When kidney stones become an emergency

Several major medical centers agree that certain symptoms with kidney stones are not “wait and see” situations they are “go now” situations.

1. Pain so severe you can’t function

Kidney stone pain is notoriously intense, but there’s a difference between “this really hurts” and “I can’t sit, stand, or think straight.” Mayo Clinic and others recommend immediate care if the pain is so bad you can’t get comfortable or it keeps getting worse.

Go to the ER if:

• You cannot find any position that eases the pain.
• Over-the-counter pain relievers are not touching it.
• You’ve been prescribed pain medicine before and it still doesn’t help.

At that point, the ER can provide IV pain medications, fluids, and quick imaging to see what’s going on.

2. Fever or chills (possible infection)

A fever with a kidney stone is a major red flag. It can mean there is an infection trapped behind a blockage, which can quickly become life-threatening.

Go to the emergency room immediately if you have kidney stone symptoms plus:

• Fever above about 101°F (38.3°C)
• Chills, shaking, or feeling unusually weak or unwell
• Rapid heart rate, confusion, or feeling “out of it”

This combination can signal a blocked, infected kidney a true emergency that may require urgent antibiotics and a procedure to relieve the blockage.

3. Persistent nausea and vomiting

Many people with kidney stones feel nauseated, especially during pain spikes. But if you can’t keep fluids or medications down, dehydration and worsening pain follow quickly.

Head to the ER if:

• You are vomiting repeatedly or constantly.
• You can’t keep water or pills down.
• You feel dizzy, lightheaded, or extremely weak.

In the ER, you can get IV fluids, nausea medication, and stronger pain control while they assess the stone.

4. Trouble peeing or no urine at all

If a stone blocks the ureter or you develop severe swelling, urine can’t drain properly. That puts pressure on the kidney and can damage it if not treated quickly.

Seek emergency care if:

• You’re peeing much less than usual.
• You feel a strong urge to urinate but almost nothing comes out.
• You stop peeing entirely over several hours and have pain or other kidney stone symptoms.

This situation is even more urgent if you have only one kidney or known kidney disease.

5. Heavy bleeding in the urine

A little blood in the urine is common with kidney stones. But large amounts, blood clots, or suddenly bright-red urine deserve urgent attention.

Go to the ER if:

• Your urine turns bright red or looks like tomato juice.
• You see clots or thick strings of blood.
• Bleeding is accompanied by severe pain, dizziness, or feeling faint.

6. High-risk medical situations

Even if symptoms seem “moderate,” some people just cannot wait things out at home.

You should strongly consider the ER (or at least same-day urgent evaluation) if you have kidney stone symptoms and:

• Only one functioning kidney
• Chronic kidney disease
• Diabetes or conditions that weaken the immune system
• Are pregnant
• Are older (for example, over 60) and feel unusually unwell

In these cases, there’s less margin for error. Complications can develop faster and be more serious.

When urgent care or your doctor may be enough

Not every kidney stone needs a late-night ER visit. In some situations, urgent care or a same-day appointment with your health care provider is more appropriate, more convenient, and definitely cheaper.

Urgent care or office visit may be fine if:

• Your pain is moderate and manageable with over-the-counter medicines.
• You have no fever, chills, or signs of infection.
• You’re able to drink fluids and keep them down.
• You’re urinating at least somewhat normally, even if it burns.

In those settings, a clinician can order imaging (usually an ultrasound or CT scan), check lab work, prescribe stronger pain medicine if needed, and help decide whether you can safely pass the stone at home.

What happens in the emergency room for kidney stones?

If you do end up in the ER, expect the team to focus on three main goals: relieve pain, rule out emergencies, and plan next steps.

1. Rapid assessment

• Vitals: blood pressure, heart rate, temperature, oxygen levels
• Questions about symptom onset, severity, past kidney stones, and medical history
• Physical exam, especially of the back, abdomen, and flanks

2. Testing

• Urine tests to look for blood, infection, and crystals
• Blood tests to check kidney function and signs of infection
• Imaging often a CT scan, sometimes an ultrasound, to locate the stone and see its size

3. Treatment

• IV pain medication and nausea medication
• IV fluids, especially if you’re dehydrated
• Antibiotics if an infection is suspected

If the stone is large, blocking urine, or associated with a serious infection, you may be admitted to the hospital. A urologist might perform a procedure such as placing a stent or using a scope or laser to relieve the blockage and remove the stone.

Can you safely manage a kidney stone at home?

Many small stones can be managed at home with your clinician’s guidance. The usual plan includes:​

• Hydration: Drinking enough fluids (unless your doctor limits fluids) to help flush the stone
• Pain control: Over-the-counter pain relievers or prescription medication
• Straining urine: Using a strainer to catch the stone when it passes, so the lab can analyze its composition
• Follow-up: Imaging and office visits to make sure the stone has passed and the kidneys are okay

However, if at any point you develop emergency symptoms fever, uncontrollable pain, vomiting, trouble urinating, or feeling very ill the at-home plan ends and the ER plan begins.

How to decide in real life: A quick checklist

When you’re in pain, thinking clearly is not always your superpower. Use this quick mental checklist:

• Is my pain unbearable or getting worse? If yes, lean toward the ER.
• Do I have a fever, chills, or feel very sick? ER.
• Am I vomiting to the point I can’t keep fluids or meds down? ER.
• Am I barely peeing or not peeing at all? ER, especially with pain or a single kidney.
• Is there heavy blood in my urine or clots? Urgent evaluation, often ER.
• Is the pain moderate, no fever, still peeing, still drinking? Call your doctor or go to urgent care.

When in doubt, especially if you have other health problems, it’s safer to be checked and told, “You’re okay to go home,” than to stay home and wish you hadn’t.

Preventing the next kidney stone (future you will be grateful)

Once you’ve experienced kidney stone pain, you’ll probably do just about anything to avoid a repeat performance. While prevention plans are very individual, many experts suggest:​

• Drinking enough fluids so your urine stays pale yellow most of the time
• Limiting excess salt, which can increase calcium in the urine
• Watching animal protein (such as large amounts of red meat) if recommended by your clinician
• Managing oxalate-rich foods (like certain nuts and spinach) in some types of stones
• Taking prescribed medications, such as thiazide diuretics or citrate supplements, if advised

A urologist or nephrologist can tailor a kidney stone prevention plan based on your stone type and lab results.

Experiences and scenarios: What kidney stone decisions look like in real life

Guidelines are helpful, but sometimes it’s easier to understand “when to go to the emergency room for kidney stones” through real-world-style stories. Here are a few composite scenarios based on common experiences. Names and details are fictional, but the decision-making process is very real.

Scenario 1: The stubborn pain warrior who waited too long

Mark is 42, generally healthy, and has had kidney stones twice before. He knows the drill: drink fluids, pace the floor, curse his kidneys, and eventually pass the stone. This time, the pain hits hard at 2 a.m. It’s worse than usual, but he decides to “tough it out.”

By 4 a.m., he’s drenched in sweat. The pain comes in waves so strong he can’t sit or lie down. He notices he hasn’t peed much for hours, and when he tries, only a few drops come out. He’s dizzy and starting to feel nauseated.

In Mark’s mind, he’s thinking, “I’ve done this before; I’ll be fine.” But based on the red flags severe, unrelenting pain and very little urine this is exactly the kind of situation where going to the ER is the safer call. There, a scan shows a larger stone lodged in his ureter, and he needs a procedure to relieve the blockage. If he had continued waiting, he could have risked kidney damage.

Scenario 2: The “mild” stone that wasn’t so mild

Jessica is 33 and has never had a kidney stone before. She develops a sharp pain in her right side that comes and goes. She assumes she pulled a muscle at the gym. By the next day, the pain is still there but manageable. She goes to urgent care, where they suspect a kidney stone and send her home with instructions to drink water and pain medication.

That night, she starts feeling chilled and a bit feverish, but she thinks it’s “just a little bug.” By morning, her temperature is over 101°F, and she has intense chills and worsening pain. Now, her situation has changed: a possible kidney stone is now paired with fever and feeling very sick classic reasons to go to the emergency room. In the ER, she’s found to have a blocked, infected kidney and needs urgent antibiotics and a drainage procedure.

Jessica’s story shows how a non-emergency kidney stone can turn into an emergency. The key is recognizing that new symptoms especially fever, chills, or feeling suddenly much worse mean it’s time to re-evaluate and seek higher-level care.

Scenario 3: The cautious call that prevented a crisis

Thomas is 68, has diabetes, and only one functioning kidney after surgery years ago. When he develops flank pain and blood in his urine, he doesn’t wait. Even though the pain isn’t unbearable yet, he knows he’s high-risk. He calls his doctor’s office, and the nurse immediately tells him to go to the ER rather than urgent care.

In the emergency room, Thomas gets priority evaluation. Imaging reveals a moderate-sized stone near the ureter. Because he has a single kidney and diabetes, the team decides not to gamble on a wait-and-see approach; they coordinate with a urologist for close monitoring and early intervention.

Thomas’s situation highlights a crucial point: when you have underlying kidney disease, a single kidney, or medical conditions like diabetes that affect your healing and infection risk, the threshold for using the ER is lower. Even “moderate” symptoms can be dangerous if something goes wrong.

Scenario 4: The successful at-home plan (with backup)

Maria is 29, otherwise healthy, and has had one small kidney stone before. When she develops flank pain and burning with urination, she goes to an urgent care clinic the same day. She has no fever, her vital signs are stable, and imaging suggests a small stone that should pass on its own. The clinician gives her pain and nausea medication, strict instructions on when to go straight to the ER (fever, vomiting, inability to pee, uncontrollable pain), and arranges a follow-up.

Over the next few days, Maria has uncomfortable but manageable pain. She drinks plenty of fluids, uses her medications properly, and strains her urine. Two days later, she passes a small stone in the strainer. Her pain eases, and at follow-up, her tests look good.

Maria’s story shows the best-case scenario: symptoms that are stable, no red flags, and a clear plan with good communication. The safety net knowing when to switch from “home management” to “get help now” is what makes at-home care safe.

Bottom line

Kidney stones are common, painful, and in most cases treatable without long-term damage. But when certain symptoms show up severe pain, fever, vomiting, trouble peeing, heavy bleeding, or serious underlying health conditions the emergency room is absolutely the right place to be.

If you’re ever on the fence, err on the side of caution. You can’t “bother” an ER by showing up with severe pain and worrying about your kidneys. That’s exactly what they’re there for.