Blood in urine due to kidney stone is common, but it should not be ignored. A stone can scratch or irritate the inner lining of the kidney, ureter or bladder. This may make urine look pink, red, brown or tea-coloured. Sometimes, urine looks normal, but blood is found only on urine testing. Kidney stone bleeding often comes with side pain, back pain, nausea, vomiting, burning urination or frequent urination. However, blood in urine can also happen due to infection, prostate problems, kidney disease or urinary tract cancer, so proper evaluation is important.

Blood in Urine Due to Kidney Stone: When Should You Worry?

A small amount of blood on urine testing can happen with kidney stones. Visible pink or red urine can also occur. But visible blood in urine should still be checked, even if you already know you have a stone.

The colour of urine does not always show how serious the bleeding is. Even a small amount of blood can change urine colour. On the other hand, some serious causes may cause only intermittent or mild-looking bleeding.

You should be more careful if:

• Blood is visible to the naked eye.
• Blood comes with fever or chills.
• Pain is severe or not settling.
• Urine contains clots.
• Blood in urine happens without pain.
• Bleeding continues after stone treatment.
• You are older than 40-50 years.
• You smoke or have a past smoking history.
• You have repeated urinary symptoms.

A kidney stone may explain the bleeding, but it should not become a reason to ignore other important causes.

What Is Hematuria?

Blood in urine is called hematuria.

There are two main types:

Both types can happen with kidney stones. Visible blood is more frightening for patients, but microscopic blood can also need evaluation depending on age, symptoms and risk factors.

Why Does a Kidney Stone Cause Blood in Urine?

A kidney stone is a hard mineral deposit that forms inside the kidney. When it moves, blocks urine flow or rubs against the urinary tract lining, it can cause bleeding.

Bleeding can happen when:

• The stone irritates the kidney lining.
• The stone scratches the ureter, which is the tube carrying urine from kidney to bladder.
• The stone causes swelling of the kidney due to blockage.
• The stone is associated with urinary infection.
• The stone reaches the bladder and causes urgency, burning or lower abdominal discomfort.

This is why many patients notice blood in urine along with colicky flank pain.

Common Symptoms With Kidney Stone Bleeding

Blood in urine from a kidney stone may come with:

• Sudden severe pain in the side, back or flank
• Pain moving from the back to the lower abdomen or groin
• Nausea or vomiting
• Burning while passing urine
• Frequent urge to pass urine
• Restlessness during pain
• Pink, red, brown or tea-coloured urine
• Pain at the tip of the penis in men when the stone is near the bladder
• Fever or chills if infection is present

Kidney stone pain often comes in waves and may not settle by simply changing position.

Can Blood in Urine Happen Without Pain?

Yes. A kidney stone can sometimes cause blood in urine without severe pain, especially if the stone is sitting inside the kidney and is not causing major blockage.

But painless blood in urine should always be taken seriously. Stones are only one possible cause. Infection, prostate enlargement, trauma, kidney disease and cancers of the bladder, kidney or prostate can also cause blood in urine.

In adults above 40-50 years, smokers, or patients with repeated painless bleeding, a urologist may advise further tests even if a stone is found. These tests may be needed to rule out bladder, kidney or other urinary tract causes.

Tests Needed for Blood in Urine Due to Kidney Stone

Your urologist will decide tests based on pain, fever, age, kidney function, urine symptoms and previous stone history.

Urine routine and microscopy

This checks red blood cells, pus cells, crystals, protein and signs of infection. It helps confirm whether the red colour is truly due to blood.

Urine culture

This is important if there is fever, burning urination, pus cells, recurrent UTI symptoms or planned stone surgery.

Serum creatinine

This checks kidney function, especially when there is vomiting, dehydration, blockage, single kidney or stones on both sides.

Ultrasound KUB

Ultrasound can detect kidney stones, swelling of the kidney, bladder stones and residual urine. It is commonly used as an initial test and is especially useful when CT needs to be avoided.

CT KUB

A non-contrast CT KUB is often the most accurate test for ureteric stones. In adults with suspected renal colic, CT is commonly used when the diagnosis is unclear, pain is severe, or treatment planning is needed. In pregnancy, ultrasound is preferred instead of CT.

Cystoscopy or CT urography in selected patients

If bleeding is painless, recurrent, associated with clots, or continues after stone treatment, your urologist may advise further hematuria evaluation. This may include cystoscopy, where a small camera is used to inspect the urinary bladder from inside.

Treatment Options

Treatment depends on stone size, stone location, pain severity, infection, kidney swelling and kidney function.

Observation and medicines

Small stones may pass naturally. Your doctor may prescribe pain medicines, anti-vomiting medicines and sometimes medicines to relax the ureter. Follow-up imaging is important to confirm that the stone has passed and the kidney is not blocked.

Do not keep taking painkillers repeatedly without evaluation, especially if pain continues or urine remains red.

Urgent drainage

If there is fever, infection with blockage, worsening kidney function, uncontrolled pain or a single functioning kidney, urgent drainage may be needed.

This can be done by:

• DJ stenting: A thin internal tube placed from kidney to bladder.
• Nephrostomy: A tube placed through the back into the kidney to drain urine.

This is done to protect the kidney and control infection before definitive stone treatment.

Stone removal procedures

Depending on the stone, treatment may include:

• URSL: Endoscopic treatment for ureteric stones.
• RIRS: Flexible laser surgery for kidney stones.
• PCNL or Mini-PCNL: Keyhole surgery for larger kidney stones.
• ESWL: Shockwave treatment for selected stones.

Blood in urine usually improves once the stone passes or is treated. If bleeding continues, further evaluation is needed.

What Should You Not Do?

Avoid these common mistakes:

• Do not assume all red urine is due to a stone.
• Do not ignore painless blood in urine.
• Do not start antibiotics without urine testing unless advised.
• Do not repeatedly self-medicate with painkillers.
• Do not force excessive water during severe pain or vomiting.
• Do not skip follow-up after the pain settles.
• Do not ignore heavy or persistent bleeding after stone surgery or stent placement.

Some foods and medicines can change urine colour, but true blood in urine should be confirmed with urine testing.

What to Bring for Consultation

Bring these reports if available:

• USG KUB report
• CT KUB scan and films/images
• Urine routine/microscopy report
• Urine culture report
• Serum creatinine report
• Previous stone analysis report
• Previous discharge summary
• Details of any DJ stent, PCNL, URSL or RIRS surgery
• Current medicines
• Photos of urine colour if bleeding is intermittent

Also note:

• When the bleeding started
• Whether pain came before or after bleeding
• Whether fever was present
• Whether urine had clots
• Whether blood appeared at the start, throughout or end of urination

FAQs

Related reading

• Kidney Stone: Symptoms, Causes and Treatment
• Kidney Stone Pain: Location, Symptoms and Relief
• Kidney Stone Pain vs Back Pain: How to Differentiate
• Fever with Kidney Stone Pain: When to Go to Hospital Immediately
• Vomiting with Kidney Stone Pain: When Is It Serious?
• Kidney Stone Treatment in Latur
• RIRS Surgery in Latur

References