Every note is a plain markdown file in a folder you choose. An assistant lives in that folder with you: it reads, searches, links and rewrites your notes, and each conversation is saved as a note beside the rest.
What do my notes say about preventing kidney stones?
Used 3 tools
Three notes cover them: Nephrolithiasis, Hypercalciuria and Thiazide diuretics. For prevention they agree on fluids (urine output over 2.5 L a day) and a normal-calcium, low-sodium diet, and thiazides lower urinary calcium in recurrent calcium stones.
Hydrochlorothiazide, chlorthalidone, indapamide. Block the Na-Cl cotransporter in the distal tubule, which raises calcium reabsorption there.
Uses
Hypertension
Recurrent calcium stones with Hypercalciuria
Nephrogenic diabetes insipidus
Adverse effects
Hypokalemia, hyponatremia
Hyperuricemia, hyperglycemia
Plain files
Markdown in a folder you own. Open it in any editor, sync it with iCloud Drive, back it up however you like. Nothing is locked in a database.
An assistant inside
Not a chat window bolted on. It works on the same files you do, with tools to read, search, edit and link them, and it keeps its chats as notes.
Nothing is lost
One undo timeline for everything, a price on every reply, a spending stop, and releases that update themselves.
A tour
Eight things Homunculus does that most notes apps don't.
Links that never break
Names are unique across the vault, so [[Nephrolithiasis]] finds the note wherever it lives. Move folders around freely. Rename a note and every link to it is rewritten. Link to a heading with # or a single paragraph with ^, and embed either with ![[…]]. Embeds are editable where they sit.
Nephrolithiasis
Hypercalciuria
Kidney stones
MedicineRenalNephrolithiasis
Nephrolithiasis
aliasesKidney stones, Renal calculi
organKidney
relatedHypercalciuria, Thiazide diuretics
+
Most stones are calcium oxalate. The commonest metabolic cause is Hypercalciuria; work through its Causes before blaming diet.
Presentation
Workup
Non-contrast CT finds stones of any composition
After a second stone, send a 24-hour urine collection
Prevention
Drink enough for over 2.5 L of urine a day (1)
See [[Thiazide diuretics]]
Stone prevention
Raise distal calcium reabsorption, so less calcium reaches the urine
Check potassium; add potassium citrate if it falls
Follow-up
Chats are notes, with their work shown
Every conversation is a markdown file. The tools it used are written into it, so you can read back what it searched for and what it changed. It reads and edits notes, finds related ones with on-device embeddings, looks at PDF pages and images, searches the web, and can run shell commands.
Kidney stones
Hypercalciuria
MedicineChatsKidney stones.md
How do I stop calcium stones coming back? Add anything missing to Hypercalciuria.
Used 4 tools
find_similar
{
"text": "kidney stone prevention"
}
82.4% Renal/Nephrolithiasis.md
Stones form when urine is supersaturated with calcium oxalate…
74.1% Renal/Hypercalciuria.md
Urine calcium above 4 mg/kg/day; the commonest metabolic cause…
66.8% Pharmacology/Thiazide diuretics.md
Lower urine calcium by increasing distal tubular reabsorption…
View PDF p.12: Brenner.pdf
Read: Hypercalciuria.md
str_replace
Three measures cut calcium stone recurrence the most:
Fluids: enough to pass more than 2.5 L of urine a day.
A thiazide for Hypercalciuria, see Thiazide diuretics.
Normal dietary calcium with less sodium and animal protein. Cutting calcium raises oxalate absorption (Brenner.pdf, p. 12).
I added these under a new Prevention heading in Hypercalciuria.
Search, Open files, or Ask AI anything…
Commands you write yourself
A command is a note whose body is a prompt. Run it from ⌘K or on selected text, and it opens a chat with the selection, the file or what you typed attached. Each command says where its chat opens: a tab, a pane, a window, a small card, a sticky, or quietly in the background.
Nephrolithiasis
Hypercalciuria
RenalNephrolithiasis
Nephrolithiasis
Most stones are calcium oxalate. The commonest metabolic cause is Hypercalciuria.
Workup
Non-contrast CT finds stones of any composition
After a second stone, send a 24-hour urine
Prevention
Drink enough for over 2.5 L of urine a day
Thiazide diuretics for hypercalciuria
make
Files
Create "make" Note
PDFs
Urology lecture 7 – Stones
Metabolic stone workup
CommandsShow all (5)
Make flashcards
Make a differential
Make a summary table
Databases made of notes
A database is a note that names its rows and columns. Rows are notes, listed by hand or found by a query like QUERY("type:drug"). Columns are properties, sections, blocks or formulas. Every cell is a full editor, and typing in one writes straight into that note. Grids (.grid.md) add an open-ended sheet of A1 cells.
Diuretics
Thiazide diuretics
PharmacologyDiuretics.md
+ Add row+ Add propertyFlip
Name ▲
site
#Mechanism
example
Carbonic anhydrase inhibitors
Proximal tubule
Inhibits carbonic anhydrase
Acetazolamide
Loop diuretics
Thick ascending limb
Blocks NKCC2
Furosemide
Osmotic diuretics
Proximal tubule and loop
Holds water in the lumen
Mannitol
Potassium-sparing diuretics
Collecting duct
Blocks ENaC or aldosterone
Spironolactone
Thiazide diuretics
Distal convoluted tubule
Blocks NCC
Hydrochlorothiazide
A whiteboard of real notes
Put notes on a canvas, add markdown boxes that render like any note, draw over all of it, and paste straight in. The board is a file too, so its links count like any other.
Renal stones board
Nephrolithiasis
MedicineRenalRenal stones board.md
Hypercalciuriadisease
aliases
workup
complication
Nephrolithiasisdisease
aliases
causes
treatment
Is a 24-h urine worth it?
Recurrent: yes, for Hypercalciuria.
React Flow
PDFs you can work in
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Renal stones review.pdf
Nephrolithiasis
RenalRenal stones review.pdf
4/18
Renal stones review4
Hypercalciuria
Hypercalciuria is the most common metabolic
abnormality found in adults with calcium stones,
present in 30% to 60% of patients evaluated after
a first episode. It is conventionally defined as
urinary calcium excretion above 300 mg/day in men,
250 mg/day in women, or 4 mg/kg/day in either sex
on an unrestricted diet. Because the risk of stone
formation rises continuously with calcium excretion,
these thresholds are arbitrary, not biologic.
Thiazide diuretics lower urinary calcium by up
to 50% through enhanced proximal and distal
calcium reabsorption, an effect that depends on
mild volume contraction and is blunted by a high
sodium intake. In randomized trials, hydrochloro-
thiazide, chlorthalidone, and indapamide each
reduced recurrent calcium stones by roughly half
over three years of follow-up.
Most patients have idiopathic hypercalciuria, in
which serum calcium is normal and no systemic cause
is found. Increased intestinal absorption, reduced
renal tubular reabsorption, and enhanced bone
resorption each contribute in varying degree, and
the trait clusters in families. Excess calcium in
the urine raises supersaturation with respect to
calcium oxalate and calcium phosphate.
Dietary calcium should not be restricted. A low
calcium diet increases intestinal oxalate uptake
and urinary oxalate, and in prospective cohorts
it was associated with more incident stones.
Sodium and animal protein restriction lowers
urinary calcium excretion and is recommended for
all patients with hypercalciuria; each 100 mmol
fall in dietary sodium lowers urinary calcium by
about 25 mg/day.
Table 2 Urinary Risk Factors for Calcium Stones
FactorThreshold
Calcium> 250 mg/day
Oxalate> 45 mg/day
Citrate< 320 mg/day
Uric acid> 800 mg/day
Volume< 2.0 L/day
Hypocitraturia
Citrate inhibits stone formation by complexing
calcium in solution and by blocking the growth
and aggregation of calcium oxalate crystals. Low
urinary citrate is found in up to half of stone
formers and is often caused by metabolic acidosis,
hypokalemia, or chronic diarrhea. Potassium
citrate raises urinary citrate and pH and reduces
recurrence; its use is limited mainly by gastro-
intestinal intolerance.
Thiazide-induced hypokalemia lowers urinary
citrate, so potassium supplements are commonly
combined with thiazides in recurrent formers.
Flashcards in the same vault
Cards are notes. Study them on an SM-2 spaced schedule, bury or suspend the ones in your way, and watch each deck's knowledge bar fill. Ask the assistant to write cards from anything you've read.
Renal
Nephrolithiasis
CardsRenalThiazides and calcium
Front
What do thiazides do to urinary calcium?
Back
Lower it — they increase distal calcium reabsorption.
Explanation
Used in Hypercalciuria to prevent recurrent calcium stones in Nephrolithiasis. Loop diuretics do the opposite.
Press space to mark good & next
Blanked+10 minAlmost+5.8 daysGot it+10.4 daysBreeze+16.2 days
11|6|31
Any note, a keystroke away
Hold ⌘ over a link, a file, a search result or an embed and the note opens in a card you can read and edit in place. Pop the card out and it becomes a sticky: a small window of its own that can float over other apps, even full-screen ones.
Nephrolithiasis
RenalNephrolithiasis
Nephrolithiasis
Thiazide diuretics cut recurrence, as do fluids and citrate.
Thiazide diureticsPharmacology
Raise distal calcium reabsorption, so urine calcium falls. First choice for stones from Hypercalciuria.
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9:41
MedicineChatsKidney stones.md
What are the main types of kidney stones?
6 minutes ago
Calcium oxalate is the most common, then calcium phosphate, uric acid, struvite and cystine. Most calcium stones come with Hypercalciuria.
6 minutes ago$0.02
Why do thiazides help with Hypercalciuria?
4 minutes ago
Thiazide diuretics increase calcium reabsorption in the distal convoluted tubule, so less calcium reaches the urine. That is why they lower the recurrence of calcium stones in Nephrolithiasis, alongside fluids and a low-sodium diet.
4 minutes ago$0.03
Make 5 cards from Nephrolithiasis
2 minutes ago
Used 6 tools
Done. Five cards from Nephrolithiasis are in Cards, due today.
just now$0.06
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2
Questions
Where are my notes stored?
In the folder you pick when you create or open a vault. They're ordinary markdown files. Homunculus keeps its settings for that vault in a hidden .homunculus folder inside it.
Which AI does it use?
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Can I bring the notes I already have?
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What do I need to run it?
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Start with a folder.
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