If you have severe flank pain, fever with pain, inability to urinate, or signs of sepsis — call 10177 or go to the nearest emergency room immediately.
Most kidney stones are extremely painful but not immediately life-threatening. Some kidney stone complications, however, are genuine emergencies. This article covers both.
When a Kidney Stone Becomes an Emergency
Obstructed Infected Kidney (Pyonephrosis)
The most dangerous kidney stone complication.
A stone that obstructs the ureter while bacteria are present upstream causes a rapidly worsening infection in the blocked kidney. This is urosepsis — a life-threatening emergency.
Symptoms: Flank pain + fever (>38°C) + chills/rigors + feeling extremely unwell. Nausea and vomiting. In severe cases: confusion, low blood pressure, fast heart rate (septic shock).
Action: Call 10177 immediately or go to the ER.
Do not wait to see if the fever settles. An obstructed infected kidney can deteriorate within hours. Emergency management: IV antibiotics + urgent ureteric decompression (nephrostomy tube or ureteric stent). This is PMB-covered as a sepsis emergency.
Acute Urinary Obstruction with Renal Failure
A stone that completely blocks a ureter causes hydronephrosis (swelling of the kidney). In a patient with: - Solitary kidney (only one functioning kidney) - Pre-existing renal impairment - Bilateral obstruction (both ureters blocked)
...complete obstruction is a renal emergency. Acute kidney injury (AKI) from obstruction requires urgent decompression.
Symptoms: Severe flank pain with decreased or absent urine output, nausea, swelling.
Action: ER immediately. Renal function tests (creatinine) confirm AKI. Urgent ureteric decompression is PMB-covered.
Severe Uncontrolled Pain
Ureteric colic is one of the most severe pains humans experience. If oral analgesia (diclofenac, paracetamol, opioids) at home fails to control the pain adequately:
- Go to the ER for IV analgesia
- IV ketorolac (NSAID) and opioids are highly effective
- ER management of acute renal colic is PMB-covered
You do not need to be in danger to go to the ER. Uncontrolled pain is a legitimate reason for emergency care.
Solitary Kidney with Obstructing Stone
If you have a solitary kidney (congenital single kidney, prior nephrectomy, or non-functioning contralateral kidney) and develop ureteric colic, this is a urological emergency regardless of fever. Any obstruction of your only functioning kidney threatens your renal function.
Go to the ER immediately and inform the triage nurse that you have a solitary kidney with suspected stone obstruction.
Emergency Coverage Summary
| Situation | PMB Status | Action |
|---|---|---|
| Fever + flank pain (obstructed infected kidney / urosepsis) | Yes — emergency PMB (sepsis DTP) | 10177 / ER immediately |
| Solitary kidney with obstructing stone | Yes — emergency PMB (acute renal obstruction) | ER immediately |
| Acute kidney failure from bilateral/solitary obstruction | Yes — emergency PMB (AKI DTP) | ER immediately |
| Severe uncontrolled renal colic (pain management) | Yes — PMB (acute event) | ER for IV analgesia |
| Uncomplicated stone passing with pain controlled at home | Acute PMB | Day-to-day oral analgesia + tamsulosin |
Signs of Sepsis — Know These
The combination of kidney stone + fever = emergency. Signs of sepsis (urosepsis):
- Temperature > 38°C or < 36°C
- Fast heart rate (> 100 beats/minute)
- Fast breathing (> 20 breaths/minute)
- Confusion or altered consciousness
- Rigors (uncontrollable shaking/chills)
- Low blood pressure (feeling faint on standing)
If you or someone with flank pain has more than one of the above: call 10177.
Billing Disputes After an Emergency
If you receive an unexpected bill after emergency kidney stone treatment:
- Confirm the claim was coded correctly — N20.0 (kidney stone), N20.1 (ureteral stone), or N20.9. Ask the hospital or urologist for the ICD-10 codes used.
- All emergency management is PMB-covered — analgesia, IV fluids, CT KUB, nephrostomy, or decompressive stenting in the setting of obstruction/sepsis cannot be billed to you beyond scheme tariff.
- Gap shortfall is legitimate — the urologist specialist shortfall above scheme rate is your responsibility (or gap cover's). Verify your gap cover claim was submitted.
- If a PMB service is billed incorrectly: Council for Medical Schemes: 0861 123 267.
If Your Pre-Auth Is Declined During an Emergency
If your scheme declines pre-authorisation for an emergency stone procedure during active sepsis or AKI:
- The ER doctor and urologist should proceed — PMB emergency treatment cannot be delayed for pre-authorisation.
- Inform the admissions office that this is a PMB emergency and treatment is proceeding.
- Submit the PMB motivation retroactively within 72 hours.
- If the claim is retrospectively denied: CMS 0861 123 267 — retroactive denial of a life-threatening emergency PMB is grounds for a formal complaint.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) ER24 (private ambulance): 084 124 Netcare 911 (private ambulance): 082 911 Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →