🪨 Men's Health

Kidney Stones (Urolithiasis) — Nigeria Guide

Q: Can I pass a kidney stone at home?

Small stones (<5 mm) can usually be managed at home with adequate hydration and diclofenac for pain. You should strain your urine to capture the stone. See a doctor if you develop fever, vomiting preventing oral fluids, severe pain not controlled by medication, or no stone passed after 4 weeks.

Q: Will I always get kidney stones once I've had one?

Without preventive measures, 50% of people have a recurrence within 5 years. With lifestyle changes — primarily adequate hydration and appropriate dietary changes — recurrence risk is greatly reduced. After a second stone, metabolic evaluation and targeted prevention are important.

Q: Do kidney stones affect kidney function?

Most stones that pass or are removed do not cause permanent kidney damage. Prolonged obstruction — stone blocking urine flow for weeks — can damage the affected kidney. This is why fever with obstruction is an emergency: infected obstructed kidney can be destroyed within hours.

Severe loin-to-groin pain, haematuria, and the treatment of urinary tract stones

Kidney stones (urolithiasis) cause some of the most severe pain a person can experience — classically a severe colicky pain radiating from the loin (back) to the groin. Nigeria's hot climate, dehydration habits, and diets high in animal protein and salt create fertile conditions for stone formation. Most small stones pass spontaneously with adequate hydration, but larger stones require urological intervention. This guide covers types, treatment, and crucially, how to prevent recurrence.

Signs and Symptoms

✓ Renal colic — sudden, severe, cramping loin-to-groin pain, waves every 20–60 minutes

✓ Haematuria — blood in urine (may be visible or microscopic)

✓ Nausea and vomiting — from intense pain and autonomic response

✓ Urinary urgency and frequency when stone reaches the ureter-bladder junction

✓ Difficulty passing urine or urinary obstruction in severe cases

✓ Fever and rigors — if infection develops above an obstructing stone — urological emergency

✓ Silent hydronephrosis — some stones cause painless kidney swelling, detected incidentally

Risk Factors

Chronic dehydration — concentrated urine promotes crystallisation; most important risk factor in Nigeria
Diet high in animal protein — increases uric acid and calcium oxalate excretion
High salt intake — increases urinary calcium
Obesity and metabolic syndrome — uric acid stones
Previous kidney stone — 50% recurrence within 5 years
Family history of kidney stones
Gout (hyperuricaemia) — uric acid stones
Recurrent UTIs — struvite (infection) stones, especially in women

When to Seek Help

EmergencySevere loin pain with fever >38°C — obstructed infected kidney is a urological emergency requiring urgent drainage

EmergencyComplete inability to pass urine with bilateral flank pain — bilateral obstruction or obstruction in a single kidney

Same dayFirst episode of renal colic — diagnosis confirmation, pain management, and imaging

Within 48 hoursColic not resolving after 48 hours of adequate hydration and analgesia — stone may need intervention

RoutineIncidental finding of kidney stone with no symptoms — metabolic evaluation and prevention strategies

Tests & Diagnosis

🧪 Non-contrast CT KUB (kidney, ureter, bladder)

Gold standard — detects >99% of stones, measures stone size and location, identifies obstruction. Available at most Nigerian radiology centres

🧪 Ultrasound KUB

Safe in pregnancy, no radiation — detects hydronephrosis and large stones. Misses small ureteric stones

🧪 Urine dipstick and MSU

Haematuria in >90%. MSU culture — detects infection above obstructing stone

🧪 Serum creatinine and eGFR

Assesses kidney function — important if obstruction suspected or bilateral stones

🧪 Serum calcium, uric acid, bicarbonate

Metabolic evaluation after first stone — detects hypercalcaemia (hyperparathyroidism), hyperuricaemia (gout), or renal tubular acidosis

🧪 24-hour urine collection

For recurrent stone formers — measures urinary calcium, oxalate, uric acid, citrate, and volume. Guides preventive treatment

Treatment Options

Pain management (acute colic)

Diclofenac 75 mg IM or IV is the most effective analgesic for renal colic — reduces ureteric spasm. Oral diclofenac 50 mg three times daily for ongoing pain. Paracetamol for additional analgesia. Opioids (tramadol, pentazocine) for severe pain not responding to NSAIDs

Hydration and watchful waiting for small stones (<5 mm)

60–80% of stones <5 mm pass spontaneously within 4 weeks. Drink 2.5–3 litres of water daily to maintain urine flow. Strain urine to collect passed stone for analysis. Alpha-blocker (tamsulosin 0.4 mg daily) increases spontaneous passage rate

ESWL — extracorporeal shockwave lithotripsy

Non-invasive fragmentation of stones using shockwaves. Best for kidney stones <2 cm and upper ureteric stones. Multiple sessions may be needed. Available at LUTH, UCH, UITH Ilorin, and some private urology centres in Nigeria

Ureteroscopy + laser lithotripsy (URS)

A ureteroscope is passed up the ureter to fragment and remove stones. Highly effective for ureteric stones of any size. Requires general anaesthesia. Available at major teaching hospitals and private urology centres

Percutaneous nephrolithotomy (PCNL)

For large kidney stones (>2 cm) or staghorn calculi — percutaneous access to the kidney. Highly effective, more invasive than ESWL or URS. Available at specialist centres

Infected obstructing stone — emergency

Urgent urological drainage — either ureteric stent or percutaneous nephrostomy. IV antibiotics. Definitive stone treatment after infection controlled. This is a life-threatening emergency

Prevention — hydration (most important)

2.5–3 litres of water daily. Enough to keep urine pale yellow at all times. Concentrated dark urine = high stone risk. Increase fluid intake in hot weather and during exercise

Dietary prevention

Reduce animal protein and salt. Maintain normal calcium intake (low-calcium diet paradoxically increases oxalate absorption). Reduce oxalate-rich foods if oxalate stones: spinach, nuts, chocolate, tea. Citrus juice (lemon juice) increases urinary citrate — a natural stone inhibitor

Medical prevention based on stone type

Calcium oxalate stones: thiazide diuretics if hypercalciuria. Uric acid stones: allopurinol + potassium citrate (urine alkalinisation). Struvite stones: eradicate urinary infection. Calcium oxalate + low citrate: potassium citrate supplements

Frequently Asked Questions

Is kidney stone pain the worst pain possible?

Renal colic is consistently rated among the most severe pains, often compared to childbirth. The pain comes in waves as the stone moves down the ureter, causing ureteric spasm. Good news: NSAIDs (diclofenac) are very effective and provide rapid relief.

Can I pass a kidney stone at home?