Lesson 1Relevant renal and urinary tract anatomy: kidney, collecting system, ureteral course, relations causing referred painThis section reviews renal and ureteral anatomy relevant to stone disease, including calyces, pelvis, ureteral narrowing points, vascular and pelvic relations, and mechanisms of referred pain to flank, groin, and genital regions.
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 factorsThis section outlines key history elements in suspected nephrolithiasis, including pain chronology, prior stones, metabolic and systemic disease, family history, diet, medications, occupation, and factors predicting complications or recurrence.
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 indicatedThis section details focused physical examination in acute flank pain, including vital signs, abdominal and costovertebral angle assessment, genital and inguinal exams when indicated, and findings suggesting alternative 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 strategiesThis section introduces stone prevention, including indications for metabolic evaluation, 24‑hour urine testing, dietary counseling, fluid goals, and pharmacologic therapies tailored to stone type and individual risk profile.
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 limitsThis section covers acute management of renal colic, including NSAID‑based analgesia, cautious opioid use, antiemetics, hydration, medical expulsive therapy evidence and limits, and criteria for observation versus admission.
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)This section summarizes key guideline and review sources for suspected kidney stones, highlighting major societies, publication years, and how to efficiently search and appraise evidence to guide diagnostic and therapeutic decisions.
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 markersThis section details initial laboratory evaluation in suspected nephrolithiasis, including urinalysis, urine microscopy, serum chemistries, renal function, and inflammatory markers, with interpretation for diagnosis and risk stratification.
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, anuriaThis section defines situations requiring emergent urology involvement, including obstructed infected systems, uncontrolled pain or vomiting, solitary kidney or renal failure, anuria, and special considerations in pregnancy and pediatrics.
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 indicationsThis section describes imaging choices for suspected stones, focusing on non‑contrast CT, ultrasound in pregnancy and young patients, limited roles of plain radiography, and when contrast studies are needed 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 factorsThis section reviews stone composition and formation, covering calcium, uric acid, struvite, and cystine stones, crystal nucleation, urinary supersaturation, infection‑related mechanisms, and metabolic and anatomic risk factors.
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/labiaThis section explains the classic and atypical clinical features of renal colic, including pain quality, timing, radiation, associated urinary and gastrointestinal symptoms, and red flags that suggest alternative or life‑threatening diagnoses.
Pain onset, severity, and colicky patternRadiation to flank, groin, and genitaliaHematuria and lower urinary symptomsNausea, vomiting, and autonomic signsRed flags for alternative diagnoses
