Lesson 1Relevant renal and urinary tract anatomy: kidney, collecting system, ureteral course, relations causing referred painReviews kidney and ureter anatomy for stone issues, including calyces, pelvis, ureter narrow points, vessel/pelvic links, and pain referral to flank, groin, and genital areas.
Renal cortex, medulla, and collecting systemRenal pelvis and calyceal anatomyUreteral course and narrow segmentsRelations to vessels, bowel, and pelvisPathways of referred flank and groin painLesson 2History elements: onset, prior stones, metabolic history, family history, medication/occupation risk factorsOutlines key history for suspected kidney stones, covering pain timeline, past stones, metabolic/systemic illness, family history, diet, drugs, job, and recurrence/complication predictors.
Character and timing of pain episodesPast stones, procedures, and outcomesMetabolic and systemic disease historyFamily history and genetic conditionsDiet, fluid intake, drugs, occupationLesson 3Physical exam maneuvers: costovertebral angle tenderness, abdominal exam, testicular/inguinal exam when indicatedDetails targeted physical exam for acute flank pain, including vitals, abdomen, costovertebral angle check, genital/inguinal exam if needed, and signs of other diagnoses.
Vital signs and overall illness severityCostovertebral angle tenderness techniqueAbdominal exam for peritonitis or massGenital and inguinal exam when neededSigns pointing away from stone diseaseLesson 4Stone prevention basics: metabolic workup indications, 24-hour urine testing, dietary and pharmacologic prevention strategiesIntroduces stone prevention, covering metabolic evaluation needs, 24-hour urine tests, diet advice, fluid targets, and drugs matched to stone type and personal risks.
Who needs full metabolic workupCollecting and interpreting 24‑hour urineFluid intake and urine volume targetsDietary sodium, protein, and oxalate advicePharmacologic prevention by stone typeLesson 5Acute management: analgesia ladder (NSAIDs vs opioids), antiemetics, medical expulsive therapy evidence and limitsCovers acute kidney stone pain relief with NSAIDs first, careful opioids, anti-nausea drugs, fluids, expulsive therapy evidence/limits, and observation vs admission criteria.
Analgesia ladder and NSAID first strategyOpioid indications and safety concernsAntiemetics and fluid managementMedical expulsive therapy evidenceDisposition, follow‑up, and return precautionsLesson 6Evidence sources: major guidelines and reviews for suspected kidney stones (names and years to search)Summarises key guidelines and reviews for kidney stones, noting societies, years, and efficient search/appraisal for diagnostic/therapeutic choices.
Major urology and nephrology guidelinesEmergency medicine stone care guidelinesHigh‑impact systematic reviews and yearsSearching PubMed and guideline portalsAppraising guideline strength and gapsLesson 7Initial diagnostics: urinalysis for hematuria/infection, urine microscopy, serum electrolytes, renal function, inflammatory markersDetails starting labs for suspected stones, including urinalysis, microscopy, blood salts, kidney function, inflammation markers, with readings for diagnosis and risk.
Urinalysis for hematuria and infectionUrine microscopy for crystals and castsSerum creatinine and estimated GFRElectrolytes, calcium, and uric acidInflammatory markers and sepsis cluesLesson 8Indications for emergent urology referral: obstruction with infection, refractory pain, impaired renal function, anuriaDefines urgent urology needs like blocked infected systems, uncontrolled pain/vomiting, single kidney failure, no urine, plus pregnancy/kids considerations.
Obstruction with sepsis or high feverRefractory pain or intractable vomitingAcute kidney injury and solitary kidneyAnuria, bilateral obstruction, pregnancyPediatric and complex comorbidity casesLesson 9Imaging strategy: when to use non-contrast CT KUB, ultrasound in pregnancy, plain radiography limitations, contrast indicationsDescribes imaging for stones, prioritising non-contrast CT, pregnancy/young patient ultrasound, plain X-ray limits, and contrast for complications.
Non‑contrast CT KUB indicationsUltrasound in pregnancy and youthStrengths and limits of plain radiographyWhen to use contrast CT or urographyRadiation exposure and dose reductionLesson 10Stone pathophysiology and types: calcium, uric acid, struvite, cystine — formation mechanisms and metabolic risk factorsReviews stone types/composition like calcium, uric acid, struvite, cystine, crystal formation, urine oversaturation, infection links, and metabolic/anatomic risks.
Calcium oxalate and calcium phosphate stonesUric acid stone formation mechanismsStruvite stones and urease‑producing bacteriaCystine stones and inherited disordersMetabolic, urinary, and anatomic risk factorsLesson 11Typical clinical presentation: colic characteristics, hematuria, nausea/vomiting, pain radiation to groin/scrotum/labiaExplains classic/atypical kidney colic features, pain type/timing/radiation, urine/GI symptoms, and red flags for other serious conditions.
Pain onset, severity, and colicky patternRadiation to flank, groin, and genitaliaHematuria and lower urinary symptomsNausea, vomiting, and autonomic signsRed flags for alternative diagnoses
