Kidney pain vs back pain: three clues that help you tell
Updated: 6 hours ago
The short answer
Most back pain is not your kidneys, and the most common kidney disease, chronic kidney disease, usually causes no pain at all. When a kidney does hurt, something sudden is happening to it, usually a stone or an infection. Three clues help you tell the difference: where it hurts, what the pain does when you move, and what comes with it. Before you decide it's just your back, take your temperature and look at your urine. Fever or chills with back or side pain, very little urine, a single kidney, sudden severe pain in an older adult, or numbness in the groin or both legs means the emergency room.
What we cover
Chronic kidney disease is usually silent. About 14 percent of US adults have it, and about 9 in 10 of them don't know it, because early stages usually have no symptoms. Source
Kidney pain is stretch pain. A stone blocks the ureter, urine backs up, the tube spasms and the kidney swells inside its capsule. Source
Location moves the odds but doesn't settle them. In about 1,000 emergency room patients scanned for a suspected stone, back pain made a stone less likely, yet about 4 in 10 people with back pain still had one. Pain that started within 6 hours meant a stone about 8 times in 10; pain lasting more than a week, about 2 times in 10. Primary source
No single clue decides it. A review of 76 studies found no single sign or symptom, including blood in the urine, that identified a stone on its own; a combination of clues did much better. Primary source
The aorta can mimic a kidney stone. In 261 people in western Sweden treated for a ruptured abdominal aortic aneurysm between 2008 and 2014, a third were first misdiagnosed; across studies, kidney stone pain and heart attack are the most common wrong diagnoses. Primary source
The back-thump test can't settle it. In 132 emergency patients, tenderness over the kidney was found in 65 percent of those with a stone and 50 percent of those without. Primary source
NSAIDs and the kidneys. Ibuprofen and naproxen can injure the kidneys, especially in people with kidney disease, diabetes or high blood pressure. Source
Timestamps
00:00 Is your back pain coming from your kidneys?
00:40 Back pain with fever or chills: go to the emergency room
01:05 Why chronic kidney disease usually doesn't hurt
01:39 How a kidney stone causes pain
02:24 The emergency room study behind the clues
02:54 Clue 1: where kidney pain is felt compared with back pain
04:21 Clue 2: how the pain changes when you move
05:30 Clue 3: fever, nausea and urine changes
06:17 Why no single symptom settles it
07:03 Four signs back pain needs the emergency room
09:14 Does the back-thump kidney test work?
10:44 What to do first: check your temperature and urine
11:18 Three lanes: ER, doctor today, or treat it as your back
12:28 Ibuprofen, naproxen and your kidneys
12:47 What to tell your doctor and which tests come next
References
Moore CL, et al. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone, the STONE score. BMJ 2014;348:g2191. https://doi.org/10.1136/bmj.g2191 Retrospective derivation and prospective validation cohort.
A combination of clinical clues predicted ureteral stones better than relying on the site of pain alone. Evidence type: derivation and validation cohort.
Dahm P, et al. A systematic review and meta-analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic. J Am Coll Emerg Physicians Open 2022;3(6):e12831. https://doi.org/10.1002/emp2.12831 Systematic review and meta-analysis.
No single clinical sign or symptom reliably settled whether suspected renal colic was a stone. Evidence type: systematic review and meta-analysis.
Higuchi H, et al. Evaluation of the usefulness of costovertebral angle tenderness in patients with suspected ureteral stone. J Gen Fam Med 2022;24(1):56-58. https://doi.org/10.1002/jgf2.581 Single-center retrospective study.
Kidney-area tenderness was present in people with and without a ureteral stone. Evidence type: retrospective study.
Smidfelt K, et al. The Impact of Initial Misdiagnosis of Ruptured Abdominal Aortic Aneurysms on Lead Times, Complication Rate, and Survival. Eur J Vasc Endovasc Surg 2017;54(1):21-27. https://doi.org/10.1016/j.ejvs.2017.03.022 Retrospective cohort study.
A third of ruptured abdominal aortic aneurysms in the studied cohort were initially misdiagnosed. Evidence type: retrospective cohort.
Azhar B, et al. Misdiagnosis of ruptured abdominal aortic aneurysm: systematic review and meta-analysis. J Endovasc Ther 2014;21(4):568-75. https://doi.org/10.1583/13-4626MR.1 Systematic review and meta-analysis.
The review identifies kidney-stone pain among common mistaken diagnoses of ruptured aortic aneurysm. Evidence type: systematic review and meta-analysis.
EAU Guidelines on Urolithiasis, 2026. https://uroweb.org/guidelines/urolithiasis/chapter/guidelines Clinical guideline.
The guideline describes urgent assessment and management when stones cause obstruction or infection. Evidence type: clinical guideline.
One study explained in plain language every week, with sources attached, plus the free kidney health guide: https://guides.selfprinciple.org/kidney
This content is for educational purposes only and is not medical advice. Always consult your healthcare provider for individual care. The views expressed are Dr. Hashmi's own and do not represent his employer.
Never start, stop, or change the dose of any prescription medication without consulting your physician.
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