Kidney Stones — Symptoms, Causes, and Treatment Options in Hyderabad
Kidney stones are among the most painful medical conditions a person can experience — and one of the most common urological problems in India. An estimated 12 to 15% of Indians develop kidney stones at some point in their lives, with the prevalence significantly higher in Telangana and Andhra Pradesh due to the climate, dietary patterns, and lower hydration habits common in this region. The good news: modern endoscopic techniques mean that the vast majority of kidney stones — including stones that were once treated with open surgery — are now removed through the natural urinary passage, or through a skin puncture smaller than a pencil, with same-day or next-morning discharge.
At KIMS Secunderabad, kidney stone treatment is performed by a team that pioneered PCNL (percutaneous nephrolithotomy) in India — the first hospital in the country to establish this technique as a standard treatment for complex kidney stones. That institutional experience, combined with both Holmium and Thulium Fiber Laser technology, the full range of access sizes from 4.8Fr ultra-mini through to standard 30Fr, and a dedicated metabolic stone clinic for recurrence prevention, means that KIMS can handle every kidney stone case from the simplest to the most complex — and provide a plan to prevent the next one.
What is a kidney stone?
A kidney stone is a hard, crystalline mass formed from minerals and salts that concentrate and crystallise in the urine. Stones form in the kidney and may remain there — causing pain only when they grow large enough to obstruct drainage — or they may travel down the ureter (the tube connecting kidney to bladder) causing the intense, colicky pain that most people associate with kidney stones. Stones vary enormously in size: from less than 1mm (visible only on imaging) to several centimetres filling the entire collecting system of the kidney (a staghorn stone).
Not all kidney stones are the same. The composition of the stone determines both why it formed and how it should be treated — both surgically and in terms of dietary and pharmaceutical prevention of recurrence:
Calcium oxalate stones
The most common type (70 to 80% of all stones). Form when urine calcium or oxalate is high, or when citrate (a natural stone inhibitor) is low. Associated with dehydration, high oxalate diet (spinach, nuts, chocolate), hyperparathyroidism, and certain medications.
Calcium phosphate stones
Less common than oxalate. Associated with high urine pH and conditions such as renal tubular acidosis.
Uric acid stones
Form in acidic urine (low pH). Associated with gout, high protein diet, diabetes, and obesity. Uniquely, small uric acid stones can sometimes be dissolved with oral medication (potassium citrate to alkalinise the urine) — avoiding surgery entirely.
Struvite (infection) stones
Form in the context of chronic urinary infection with urea-splitting organisms. Can grow very rapidly and form large staghorn stones. Treatment requires both stone removal and definitive treatment of the underlying infection.
Cystine stones
Rare, caused by a genetic disorder of amino acid transport (cystinuria). Often recurrent and require long-term specialist management.
KIMS performs stone composition analysis on all surgically removed stones — providing the specific information needed to tailor dietary advice, urinary alkalinisation, and pharmaceutical prevention to the exact stone type. Knowing what your stone is made of is the single most important factor in preventing the next one.
If a patient experiences severe pain accompanied by fever, chills, or the inability to urinate — go to KIMS Emergency immediately or call 040 - 44885000. These can be signs of a blocked, infected kidney (pyonephrosis), which is a medical emergency requiring immediate intervention.
Kidney stone symptoms — what they feel like
Kidney stone symptoms depend on where the stone is and whether it is obstructing urinary flow. Small stones in the kidney may produce no symptoms for years — discovered only on imaging performed for another reason. Stones that move into the ureter and obstruct urine drainage produce some of the most distinctive and severe symptoms in all of medicine.
Renal colic — severe, cramping pain in the flank (side of the back, below the ribs)
Wave-like pain that typically radiates forward and downward toward the groin
Haematuria (blood in the urine) — urine appearing red, pink, or tea-colored
Nausea and vomiting — visceral responses triggered by the intensity of pain
Urgency and frequency — bladder irritation symptoms as stones reach the ureterovesical junction
Reduced or absent urine output — a critical sign of obstruction in a solitary kidney or bilateral stones
Fever and chills with loin pain — indicates sepsis from an infected, obstructed kidney (pyonephrosis)
Microscopic blood detection — often the only sign found in early urine testing
KIDNEY PAIN + FEVER = SURGICAL EMERGENCY
Kidney pain with fever is a surgical emergency. Do not wait to see if it improves. Call KIMS on 040 - 44885000 immediately or proceed to the KIMS emergency department. An infected, obstructed kidney can cause septic shock within hours. A combination of fever and kidney pain indicates sepsis from an infected, obstructed kidney (pyonephrosis) — the kidney must be drained urgently.
Diagnosis — how kidney stones are identified
Modern kidney stone diagnosis involves three levels of investigation — each providing different information that guides treatment planning. At KIMS, we use these diagnostic tools to create a precise surgical or medical map before intervention.
Urine Analysis
A urine dipstick and microscopy is the first investigation — detecting blood, nitrites (suggesting infection), pH, and crystals. This takes minutes and is performed at the first consultation.
Ultrasound (KUB)
Identifies stones in the kidney and hydronephrosis (swelling). Ultrasound is radiation-free and available immediately — but it may miss stones in the ureter and small stones below 3mm.
Non-Contrast CT KUB
The gold standard. Detects stones as small as 1mm anywhere in the urinary tract and measures stone density (Hounsfield Units) to influence laser settings during surgery.
Stone Composition Analysis
Using infrared spectroscopy to identify the stone's chemical makeup precisely. This is the single most important test for tailored recurrence prevention.
Kidney stone treatment options at KIMS — matched to stone size and location
The choice of kidney stone treatment depends primarily on stone size, location in the urinary tract, stone density (hardness), and the patient's anatomy. KIMS offers the full range of stone treatment modalities — from medical management for small stones through to complex percutaneous access for staghorn stones — and the recommendation is always the most effective, least invasive option appropriate for that stone:
Conservative management (stones under 6mm in ureter)
Small ureteric stones under 6mm have a reasonable chance of passing spontaneously with adequate hydration and time. Medical expulsive therapy — alpha-blockers (tamsulosin) to relax the ureteric smooth muscle increases the probability of spontaneous passage and reduces the pain associated with ureteric spasm. KIMS manages patients with small ureteric stones conservatively with a defined review interval typically 4 to 6 weeks before proceeding to surgical intervention if the stone has not passed.
RIRS — Retrograde Intrarenal Surgery (stones up to 2cm, ureteric stones)
RIRS is the most minimally invasive surgical approach performed entirely through the natural urinary passage without any skin incision or kidney puncture. A flexible digital ureteroscope passes through the urethra and bladder into the ureter and kidney. The stone is targeted with Holmium or Thulium Fiber Laser energy, which fragments or dusts it into particles small enough to flush out in the urine naturally. KIMS uses both Holmium laser (100W+) and the newer Thulium Fiber Laser (TFL) — which achieves sub-0.5mm stone dusting more efficiently than Holmium at equivalent settings, reducing the risk of residual fragments. RIRS at KIMS is a day-care procedure patients arrive in the morning and go home the same evening in most cases. A temporary ureteric stent (JJ stent) is often placed for 2 to 4 weeks post-procedure to allow the ureter to heal and facilitate passage of stone dust. The stent is removed as a short outpatient procedure at the follow-up visit. RIRS is suitable for most stones in the kidney and ureter up to 2cm, and for selected 2 to 3cm stones depending on composition and location.
Mini-PCNL — Miniaturised Percutaneous Nephrolithotomy (stones 2–4cm and above)
For stones above 2cm, or for stones that are very hard (high Hounsfield Units on CT indicating dense calcium oxalate monohydrate or cystine composition that resists laser dusting), direct access to the kidney through the skin is more effective. KIMS performs Mini-PCNL using sheaths from 4.8Fr ultra-mini (less than 2mm skin puncture) through to 15Fr mini providing the efficiency of direct stone access with blood loss and recovery time significantly less than standard PCNL. Tubeless PCNL — where no nephrostomy drain tube is left after the procedure is offered for selected straightforward cases, enabling same-day or next-morning discharge. KIMS was the pioneer of PCNL in India — the first hospital in the country to perform this technique and establish it as the standard approach for complex kidney stones. This 40-year institutional experience with the full range of percutaneous access sizes means that KIMS manages staghorn stones, horseshoe kidney stones, stones in transplanted kidneys, and other complex anatomical situations that most centres in India cannot handle.
The KIMS metabolic stone clinic — treating the cause, not just the stone
Most patients who have a kidney stone removed are simply discharged with dietary advice to drink more water. At KIMS, patients with a first stone — and certainly all patients with recurrent stones — are referred to the KIMS metabolic stone clinic for a dedicated investigation into why the stone formed.
The Metabolic Workup Includes:
24-hour urine collection
Measuring daily calcium, oxalate, uric acid, citrate, phosphate, sodium, and total volume. This identifies the specific metabolic abnormality driving stone formation.
Serum biochemistry
Testing calcium, phosphate, uric acid, parathyroid hormone (PTH), and Vitamin D to exclude systemic causes like hyperparathyroidism.
Stone composition analysis
Infrared spectroscopy of the retrieved stone to identify its precise chemical makeup.
Dietary review
Identifying high-oxalate foods, excess sodium, and other dietary contributors specific to your stone type.
Based on the metabolic workup, the KIMS nephrologist and urologist together formulate a personalised recurrence prevention plan — which may include specific dietary modifications, urinary alkalinisation (potassium citrate for uric acid and calcium oxalate monohydrate stones), thiazide diuretics (for hypercalciuria), allopurinol (for hyperuricosuria), or other targeted interventions. With appropriate metabolic management, recurrence rates for many stone types can be reduced by 50% or more.
If you have had more than one kidney stone, ask specifically for a metabolic stone workup at your KIMS consultation. The 24-hour urine collection is the most important investigation most stone patients never receive — and it identifies treatable abnormalities in the majority of recurrent stone formers.
Why patients choose KIMS Secunderabad for kidney stone treatment
KIMS Laser Stone Centre combines historical expertise with the latest dual-laser technology to provide comprehensive care from emergency removal to long-term prevention.
Pioneer PCNL Centre
KIMS performed the first PCNL in India and has the deepest institutional experience with the full range of percutaneous access sizes from 4.8Fr to 30Fr. This verifiable, historic distinction means our urologists have been performing these procedures at high volume since before they became the national standard of care.
Dual Laser Technology — Holmium AND Thulium
KIMS operates both 100W+ Holmium and Thulium Fiber Laser (TFL) systems. Holmium provides efficient fragmentation, while TFL allows for fine dusting of hard stones to sub-0.5mm particles—significantly reducing residual fragment rates. Having both allows our surgeons to choose the right tool for each stone.
Complete RIRS and PCNL Capability
KIMS handles the full spectrum from simple ureteric stones to complex staghorn stones, bilateral stones, and stones in anatomically challenging kidneys. High-volume, dedicated stone programmes consistently outperform general urology departments for stone clearance and safety.
Metabolic Stone Clinic — Treating the Cause
Removing the stone is only half the job. KIMS runs a dedicated metabolic stone clinic providing 24-hour urine risk profiles and personalized dietary plans. Most stone centres do not offer this dedicated investigation of stone-forming causes for personalized recurrence prevention.
Tubeless Mini-PCNL & Same-Day RIRS
RIRS at KIMS is designed as a day-care procedure. We also offer Tubeless Mini-PCNL for selected patients, allowing them to go home the same day or next morning with no nephrostomy drain, avoiding unnecessary hospital stays.
NABL Laboratory & Tertiary Support
Our NABL-accredited laboratory performs in-house stone composition analysis with fast turnaround. As a 1,000-bed hospital, every medical specialist and advanced ICU facility is immediately available if complications like infection arise, unlike standalone clinics.
Aarogyasri, CGHS, and EHS Empanelled
KIMS Secunderabad accepts Aarogyasri (PMJAY), CGHS, and EHS. RIRS and PCNL procedures are covered for eligible patients, and all major private insurance/cashless options are accepted.
Frequently Asked Questions — Kidney Stones
The most characteristic symptom of a kidney stone that has moved into the ureter is severe, cramping flank pain (renal colic) — radiating from the back down toward the groin — often accompanied by nausea and blood in the urine. However, not all kidney stones cause pain: stones that remain in the kidney may be completely silent and discovered only on imaging. If you have severe unexplained back or flank pain, visible blood in the urine, or a combination of fever and back pain, seek medical attention immediately. A urine test and ultrasound or CT scan will confirm whether a stone is present.
Stones below 6mm in the ureter have a reasonable chance of passing spontaneously with hydration and medical expulsive therapy (tamsulosin) — a defined monitoring period of 4 to 6 weeks is standard. Stones in the kidney are considered for intervention based on size, symptoms, and whether they are causing obstruction. Stones above 10mm anywhere in the urinary tract, stones causing persistent obstruction or infection, and all stones above 6mm that have not passed within 4 to 6 weeks of observation are generally recommended for surgical removal. At KIMS, the decision is made based on CT findings including stone size, density, and location.
It depends on the stone. RIRS (retrograde intrarenal surgery) is the less invasive procedure — no skin puncture, and day-care in most cases. It is the preferred approach for stones up to 2cm in most locations and for all ureteric stones. PCNL (and Mini-PCNL) provides more direct and efficient access for stones above 2cm, very hard stones (high Hounsfield Units on CT), or stones in anatomically challenging locations where the flexible ureteroscope cannot reach effectively. The KIMS urologist recommends the most effective, least invasive approach based on the CT findings for each individual stone.
Whether a stone will pass depends primarily on its size and location. Stones in the ureter below 6mm often pass with time, hydration, and medical expulsive therapy. Stones in the kidney do not pass spontaneously — they require either monitoring (if small and asymptomatic) or surgical removal. Stones above 6mm in the ureter, all large kidney stones, and any stone causing infection or significant obstruction require surgical intervention. At the KIMS consultation, the CT findings will be used to give you a specific recommendation.
Recurrence rates without prevention are high — approximately 50% within 10 years. The most effective strategies are personalised to the stone type via stone analysis and a 24-hour urine collection. General measures: drink enough fluid to produce at least 2.5 litres of urine per day (urine should be pale), reduce sodium intake, and maintain a healthy weight. Stone-type-specific interventions — like dietary oxalate restriction or urinary alkalinisation — are prescribed after metabolic workup at the KIMS metabolic stone clinic.
Yes — if left untreated, stones can cause permanent damage through obstructive nephropathy: a stone blocking drainage causes progressive pressure damage (hydronephrosis). While the kidney can tolerate obstruction for several weeks, damage can become irreversible. When combined with infection (pyonephrosis), kidney damage occurs much more rapidly and carries life-threatening sepsis risks. Stones should not be left untreated simply because they are 'not causing pain' — painless obstruction is just as damaging.
Both RIRS and Mini-PCNL are well-established, safe procedures with low complication rates. Specific risks of RIRS include UTI, temporary ureteric spasm, or (very rarely) ureteric injury. Risks of Mini-PCNL include bleeding, post-operative fever, or injury to adjacent structures. At KIMS, pre-operative urine culture and sensitivity testing is mandatory to identify and treat infection before the procedure, which is the most important risk reduction step for both procedures.
KIMS Secunderabad — India's pioneer PCNL centre, featuring dual Holmium and Thulium Fiber Laser for RIRS, a full range of Mini-PCNL access sizes, and a dedicated metabolic stone clinic for recurrence prevention. We are NABL-accredited for stone analysis and Aarogyasri, CGHS, and EHS empanelled. Contact 040 - 44885000 to book a consultation with the KIMS kidney stone team.