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urology

Blood in Urine and Kidney Stones: What to Expect

Kidney stones frequently cause blood in the urine — ranging from a faint pink tint to visibly red urine — usually alongside flank or back pain. Hematuria from a stone still requires evaluation to confirm the cause and rule out other conditions. A urologist manages kidney stone care.

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Why do kidney stones cause blood in the urine?

As a kidney stone moves through the urinary tract — from the kidney into the ureter (the tube connecting kidney to bladder) and eventually into the bladder — its edges can scrape and irritate the delicate lining of the urinary tract. This trauma causes bleeding that enters the urine stream.

The blood may appear as: - Pink or light red urine - Visibly red or tea-colored urine in more significant bleeding - Microscopic hematuria visible only on a lab test, with no obvious color change

The amount of blood in the urine does not reliably indicate the size of the stone or the severity of the situation. Even a small stone passing through a sensitive area can cause noticeable bleeding.

What does kidney stone pain feel like alongside the blood in urine?

Kidney stones are well known for causing severe, cramping pain — often called renal colic. The classic pattern is:

  • Flank pain — an intense ache or spasm in the side or back, just below the ribs
  • Pain that radiates toward the lower abdomen, groin, or inner thigh as the stone moves lower
  • Pain that comes and goes in waves, often with brief periods of relief between episodes
  • Nausea and vomiting often accompany the pain
  • Urinary frequency and urgency when the stone is near the bladder

Some stones — particularly those sitting still in a kidney — can be present without causing pain, and hematuria may be the only sign. 1

If a stone becomes stuck and blocks urine flow, there is a risk of a urinary tract infection developing behind the blockage. This combination (obstruction plus infection) can become serious and may require urgent intervention.

How do doctors confirm a kidney stone is causing the hematuria?

Evaluation typically includes: 23

  • Urinalysis — confirms hematuria and checks for signs of infection
  • CT scan of the abdomen and pelvis (non-contrast) — the most sensitive imaging test for detecting stones, showing their size and location. This is usually the first-line imaging study for suspected renal colic
  • Ultrasound — can detect stones and obstruction without radiation, often used in pregnancy or when repeated imaging is a concern
  • Blood tests — kidney function (creatinine) and electrolytes may be checked, especially if there is significant obstruction or infection is suspected

A urologist uses this information to determine how the stone should be managed and whether any intervention is needed.

How are kidney stones with hematuria treated?

Treatment depends on the size and location of the stone, as well as whether there is pain, infection, or obstruction. 1

Small stones (typically under 5–6 mm) often pass on their own with hydration, pain management, and sometimes a medication that relaxes the ureter to help the stone pass. Most small ureteral stones pass within a few weeks.

Larger stones or those causing obstruction or infection require urological intervention: - Shockwave lithotripsy (SWL) — uses focused sound waves to break the stone into smaller fragments that can pass - Ureteroscopy with laser lithotripsy — a scope is passed through the urethra and bladder into the ureter to break up or remove the stone directly - Percutaneous nephrolithotomy (PCNL) — a minimally invasive procedure through the back, used for large or complex stones

After a stone episode, a urologist may recommend stone analysis and dietary changes or medications to reduce the risk of future stones. 1

Can blood in the urine from a kidney stone be mistaken for something more serious?

Hematuria always requires evaluation to confirm its cause — even when a stone seems like the obvious explanation. A urologist will often ensure that the hematuria resolves after the stone is treated. If hematuria persists without an active stone, further evaluation for other causes (including bladder or kidney tumors) is warranted. This follow-through is standard practice and should not be alarming — it reflects appropriate, thorough care.

Gale can connect you with a urologist and help you prepare for your evaluation and any follow-up appointments.

Common questions

Does blood in the urine always mean the kidney stone is moving?

Not necessarily. A stone sitting in the kidney can cause intermittent bleeding without passing or causing pain. Blood in the urine alongside no pain may still indicate a stone — or another cause — and should be evaluated.

How much blood in the urine is normal with a kidney stone?

There is no amount of blood in the urine that is expected or normal. Even if it is almost certainly from a stone, the amount does not reflect the severity. A clinician should evaluate and confirm the cause.

Will passing a kidney stone stop the bleeding?

In most cases, once the stone has passed, the irritation causing the bleeding resolves and the urine clears. If hematuria continues after the stone has passed, let your clinician know — further evaluation may be needed.

Should I go to the emergency room for kidney stone pain and blood in my urine?

If the pain is severe and uncontrolled, you have a high fever, you have only one kidney, or you have signs of infection alongside obstruction — yes, go to the emergency room. For moderate pain with no fever, urgent care or a same-day primary care visit is appropriate.

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When to seek urgent care

  • —Severe, uncontrolled flank or abdominal pain
  • —Fever above 38.5°C (101.3°F) with flank pain — may indicate a kidney infection behind a blocked stone
  • —Inability to urinate despite feeling the urge
  • —Known single kidney with signs of obstruction
  • —Vomiting so severe that you cannot keep fluids down

Fever with kidney stone pain is a potential emergency — go to an emergency room promptly. An infected, obstructed kidney requires urgent treatment.

This article is for general educational purposes only and does not replace a clinical evaluation. A urologist is the right specialist for kidney stone diagnosis and management. Gale can help you find a urologist and prepare for your visit.

References

  1. 1.Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TMT, White JR (2014). Medical Management of Kidney Stones: AUA Guideline. Journal of Urology. doi:10.1016/j.juro.2014.05.006 ✓Treatment thresholds, stone passage rates, and management options for kidney stones including hematuria context
  2. 2.National Institute of Diabetes and Digestive and Kidney Diseases (2023). Definition & Facts for Kidney Stones. NIDDK. link ✓Overview of kidney stone symptoms including hematuria, pain patterns, and diagnostic approach
  3. 3.National Institute of Diabetes and Digestive and Kidney Diseases (2023). Diagnosis of Kidney Stones. NIDDK. link ✓Non-contrast CT as first-line imaging for suspected renal colic; ultrasound as an alternative in pregnancy; blood and urine tests in evaluation

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.