October 2026 English edition · Evidence reviewed through October 3, 2026 · David Shusterman, MD

Appendix F: The Kidney Stone Emergency Action Plan

This plan is designed for a person who has already been evaluated and has an individualized strategy from a clinician. New, severe, or atypical pain still requires diagnostic assessment because appendicitis, vascular disease, infection, ovarian disease, bowel disease, and other conditions can mimic a stone.

At the First Sign of a Familiar Episode

Note the time and location of pain, whether it migrates, associated nausea or vomiting, urinary symptoms, visible blood, and the most recent urine output. Check temperature with a thermometer. Use only medications that were prescribed or previously approved for you, and follow the dose limits and contraindications provided by your clinician. Do not combine NSAIDs or take them when you have been advised to avoid them because of kidney disease, ulcer disease, anticoagulation, allergy, pregnancy, or other risk.

Hydrate normally and replace reasonable losses. Do not force large volumes in an attempt to hydraulically push through a complete obstruction. If nausea is present, small frequent sips may be more tolerable. Strain urine when feasible and place any recovered material in a clean, dry container.

Call the Treating Clinician Promptly

Contact the office when pain is recurrent but manageable, the diagnosis has not been confirmed for the current episode, prescribed medications are inadequate, vomiting is developing, urine output is falling, symptoms persist longer than expected, or you need a follow-up imaging plan. People with a solitary kidney, known chronic kidney disease, urinary reconstruction, transplant, pregnancy, immunosuppression, or recurrent infected stones should use a lower threshold for contacting their care team.

Go to the Emergency Department

Seek urgent emergency assessment for fever or shaking chills with flank pain; confusion, fainting, marked weakness, or low blood pressure symptoms; inability to keep down fluids or medications; uncontrolled pain; markedly reduced or absent urine; suspected obstruction of a solitary functioning kidney; pregnancy with significant pain or systemic symptoms; or any rapidly worsening condition.

An infected obstructed collecting system is a urological emergency. Antibiotics alone may not be sufficient when infected urine cannot drain. Urgent decompression may require a ureteral stent or nephrostomy tube, followed by definitive stone treatment after stabilization.

What to Bring

Bring a current medication list, allergies, prior stone analyses, recent imaging reports or access information, relevant 24-hour urine results, kidney-function history, operative history, and the name of your urologist. Tell the emergency team immediately about pregnancy, a solitary kidney, kidney transplant, anticoagulants, immune suppression, or prior sepsis.

Questions That Clarify the Decision

Ask whether there is obstruction, infection, acute kidney injury, a solitary-kidney threat, or uncontrolled symptoms. Ask the stone size and location, the expected likelihood of passage, what follow-up is required, and what finding would change the plan from observation to intervention.

One-Page Episode Log

Pain began: date and time.

Pain location and migration: flank, abdomen, groin, or side.

Temperature: exact reading and time.

Vomiting: count; can fluids and medication stay down?

Urine output: normal, reduced, or absent.

Medications taken: name, dose, and time.

Red flags: chills, confusion, solitary kidney, pregnancy.

Clinician contacted: name, time, instructions.

The purpose of the action plan is not to avoid the hospital at all costs. It is to distinguish a monitored, uncomplicated episode from a threat to organ function or life.