Snapshot A 36-year-old woman presents to the emergency department with severe and colicky left flank pain that radiates to the left groin. She reports increased urinary frequency and urgency. She is sexually active with multiple men and uses condoms inconsistently. On physical exam, there is left-sided costovertebral angle tenderness and lower abdominal tenderness. Introduction Clinical definition login to view 1 more bullet Epidemiology login to view 20 more bullets Pathogenesis login to view 2 more bullets Prognosis login to view 1 more bullet Nephrolithiasis Stones Stone Type Etiology Imaging Findings Stone Shape Treatment Calcium Calcium oxalate stones (most common) hypercalciuria hypocitraturia ethylene glycol (antifreeze) vitamin C abuse crohn disease Calcium phosphate in states of urine alkalinization e.g., type I renal tubular acidosis Radiography radiopaque Computerized tomography radiopaque Envelope or dumbbell shape calcium oxalate Wedge-shaped prism calcium phosphate Hydrochlorothiazide Citrate Low-sodium diet Cystine Impaired cystine reabsorption in the proximal convoluted tubule this results in cystinuria also results in decreased reabsorption of ornithine, lysine, and arginine Precipitates in acidic urine Diagnosis cyanide-nitroprusside test Radiography radiolucent Computerized tomography visible at times Hexagonal Dietary modification low sodium Urine alkalinization Chelating agents in refractory cases Struvite (magnesium ammonium phosphate) Urease-positive organisms such as Proteus mirabilis Staphylococcus saphrophryticus Klebsiella Urease-positive organisms subesequently alkalinizes the urine this causes struvite stones due to precipitation Radiography radiopaque Computerized tomography radiopaque Can result in a staghorn calculi Coffin lid Removal of underlying infection Surgical removal of the stone Uric acid Hyperuricemia e.g., states of increased cell turnover and gout Precipitates in acidic urine Radiography radiolucent Computerized tomography minimally visible Rhomboid/rosette Urine alkalinization Allopurinol Adequate hydration prior to chemotherapy treatment Presentation Symptoms login to view 4 more bullets Physical exam login to view 2 more bullets Imaging Renal ultrasound login to view 4 more bullets Non-contrast computerized tomography (CT) login to view 4 more bullets Studies Labs login to view 9 more bullets Diagnostic criteria login to view 1 more bullet Differential Urinary tract infections Acute pyelonephritis Groin hernia Complications Ureteral obstruction Ureteral stricture Urinary tract infection Renal deterioration