Fever and a stone
This can be a life-threatening emergency. The kidney is essentially a blood filter. If it becomes obstructed and there are bacteria in the kidney, these bacteria can quickly move into the blood stream. The first signs of this are fever or an elevated white blood count. The next signs, particularly in frail individuals, can be severe whole body sepsis and even death. If an obstructing stone is associated with fever, this is a true emergency and urgent drainage (by either a ureteral stent or a nephrostomy tube) is necessary.
Occasionally a person may have stones blocking both kidneys at the same time or may only have one kidney that works. In this case, there is a significant risk of build-up of waste products in the blood that normally would be excreted by the kidneys. In this situation, urgent drainage is required.
Need for hospitalization
While the vast majority of patients with kidney stones do not need to be admitted to the hospital, sometimes hospitalization is necessary. Reasons for admission include:
If pain cannot be controlled in the emergency room, admission to the hospital and continuous IV narcotics may be required. If the pain does not settle within a short period of time surgical procedures may be needed. The procedure would depend on the stone’s size and location.
Patients who cannot keep fluids down cannot be allowed to leave the emergency room. In that situation, admission to the hospital and administration of IV fluids and potent anti-nausea medication (anti-emetics) may be necessary.
An admission to the hospital does not necessarily mean that a stone needs to be treated immediately. Many small stones will still pass on their own and larger, more complex stones may be better managed electively after the current crisis resolves.