The main symptoms are pain and hematuria. Only a few large, immobile stones in the renal pelvis, without obvious obstruction and infection, can be asymptomatic for a long time, or even the affected kidney completely loses its function, and the symptoms are still not obvious. It is not discovered until hydronephrosis or infection occurs. The degree is related to factors such as the location, size, mobility of the stone, the presence or absence of complications and their degree. The smaller the stone, the more obvious the symptoms.

Renal colic occurs when small stones in the renal pelvis can cause smooth muscle spasm due to their large mobility and direct stimulation, or when stones become lodged at the junction of the renal pelvis and ureter and cause acute obstruction. Hematuria occurs after colic, and stones may gradually grow to cause chronic obstruction, hydronephrosis and pyuria. In cases of single or double kidney stones, complete obstruction may occasionally occur. Due to the renal-renal reflex mechanism, it may cause acute anuria or even acute renal insufficiency. Some patients seek treatment for anemia, gastrointestinal symptoms or urinary tract infection, which can easily lead to misdiagnosis.