Kidney Stones: Do They Always Cause Blood in Urine?

Q: Kidney Stones: Do They Always Cause Blood in Urine?

Hello： Hematuria is not always present with kidney stones; if the stone is very small, it may not cause any bleeding (no damage). <br>However, a single normal urinalysis does not guarantee that there are no issues, as the likelihood of stones remains significant. <br>If there is

Regarding stone issues?

Hello, earlier this year, I went to the emergency room due to severe pain in my left flank.
I underwent urinalysis and X-ray examinations, which showed no abnormalities, but I had hematuria.
The emergency physician diagnosed the pain as being caused by kidney stones.
After emergency treatment, I continued with follow-up care in the outpatient clinic.
The outpatient physician performed imaging studies and found a stone in the ureter.
After about three weeks of medication treatment, my urinalysis returned to normal.
However, last week, I started experiencing pain again in my left flank (near the left kidney).
Although it wasn't as severe as the previous pain, I still went to the outpatient clinic.
The physician only conducted a urinalysis and explained that the urine was normal, with no proteinuria, suggesting that it might not be a stone issue.
I would like to ask if kidney stones always cause hematuria, or should I consider consulting a physician from another specialty?

Niming, 30~39 year old female. Ask Date: 2018/06/19

Dr. Du Shixi reply Urology

Hello: Hematuria is not always present with kidney stones; if the stone is very small, it may not cause any bleeding (no damage).
However, a single normal urinalysis does not guarantee that there are no issues, as the likelihood of stones remains significant.
If there is a history of kidney stones, they are likely to recur.
Lifestyle changes are essential: drink plenty of fluids, avoid excessive salt intake, engage in moderate exercise, and refrain from consuming sugary beverages to reduce the risk of developing stones.
If symptoms of flank pain persist, it is advisable to follow up with a urologist.
Wishing you good health.

Reply Date: 2018/06/19

More Info

Kidney stones, also known as renal calculi, can indeed cause a variety of symptoms, including hematuria (blood in urine). However, it is important to understand that not all cases of kidney stones will present with blood in the urine. The presence of blood can depend on several factors, including the size and location of the stone, the degree of obstruction it causes, and whether it has caused any damage to the urinary tract.

When a kidney stone moves through the urinary tract, it can irritate the lining of the ureters, bladder, or urethra. This irritation can lead to micro-tears or abrasions, resulting in bleeding. In many cases, this bleeding can be microscopic and not visible to the naked eye, but in some instances, it can lead to gross hematuria, where the urine appears visibly red or brown.
In your case, you mentioned experiencing severe pain in your left flank, which led to an emergency visit. The initial tests showed blood in your urine, which the emergency physician attributed to the possibility of kidney stones. However, subsequent imaging and urine tests indicated no stones were present, and your urine returned to normal after treatment. This suggests that while kidney stones can cause hematuria, the absence of stones in later tests indicates that other factors could be at play.

It is also possible for other conditions to cause hematuria, including urinary tract infections (UTIs), bladder or kidney infections, trauma, or even tumors. Given that your urine tests have returned to normal and there is no proteinuria, it may be prudent to consider other potential causes for your symptoms.
If you are experiencing recurrent pain in the same area, it may be beneficial to consult with a urologist or another specialist who can perform further evaluations. This could include imaging studies such as a CT scan, which is more sensitive in detecting stones than X-rays, or a cystoscopy, which allows direct visualization of the bladder and urethra.

In summary, while kidney stones can cause blood in the urine, they do not always do so. The absence of blood in subsequent tests and the normal urine findings suggest that your current symptoms may not be related to stones. It would be wise to follow up with a specialist to explore other potential causes for your pain and ensure that any underlying issues are addressed. Regular monitoring and communication with your healthcare provider are essential in managing your symptoms and maintaining your urinary health.

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