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Master Clinical Nephrology with Expert-Crafted Scenarios
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Scleroderma Renal Crisis: ACE Inhibitor First, Steroids Out
Scleroderma Renal Crisis (SRC) is a life-threatening complication of systemic sclerosis (SSc), classically presenting wi...
Hypokalaemia With Normal-Anion-Gap Acidosis: RTA vs Diarrhoea
Hypokalemia with metabolic acidosis is a challenging clinical scenario that requires a systematic approach to uncover th...
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Renal artery stenosis: non-surgical treatment (medical therapy versus revascularisation)
Bottom line (ESC 2024 hypertension guideline): in atherosclerotic renal artery stenosis give medical therapy first: ACEI...
Approach to a patient with haematuria and normal kidney function — step by step as a nephrologist
Bottom line (UK Renal Association / BAUS algorithm): exclude UTI and transient causes, confirm non-visible haematuria on...
Incremental haemodialysis: what is it, who is a candidate, and how do you prescribe and monitor it?
Incremental HD = starting with less than thrice-weekly dialysis (usually twice weekly) because residual kidney function...
Treatment of lupus nephritis (and SLE) according to the 2025 guidelines: give me your algorithm
The 2025 message is upfront combination therapy: active class III/IV (± V) gets glucocorticoid pulses with a fast taper...
AKI in Rheumatoid Arthritis: Hidden Methotrexate Toxicity and Bilateral Kidney Stones
A woman with rheumatoid arthritis on hydroxychloroquine (Plaquenil) is referred with AKI, creatinine 200 µmol/L. I start...
Lupus Nephritis: Planning Pregnancy and the Proteinuria Rise After MMF to Azathioprine
A woman with class III lupus nephritis in remission for 5 years (normal kidney function, proteinuria 400 mg/day) wants t...
A diabetic patient with ESKD comes for counselling before starting RRT: which is better for him, peritoneal dialysis or haemodialysis?
Bottom line: neither is better for diabetics as a group, because there is no evidence of superiority of one modality in...
Cinacalcet versus etelcalcetide: how do you choose, prescribe and switch in dialysis secondary hyperparathyroidism?
Oral daily versus IV after HD: both activate the calcium-sensing receptor and lower PTH; etelcalcetide gives supervised...
Kidney-transplant recipient, 6 years out, graft stable: what late complications do you screen for and how do you reduce his cardiovascular, cancer and diabetes risk?
Bottom line: late care is surveillance: the graft (creatinine, proteinuria, DSA, adherence), cardiovascular risk (statin...
Man who donated a kidney ten years ago: creatinine now 1.3 mg/dL (was 0.9), blood pressure 145/92 and urine ACR 50 mg/g. How do you interpret this and what do you do?
Bottom line: a modest creatinine rise alone is expected after donation, but new hypertension plus albuminuria is not rea...
Kidney-transplant recipient 15 years out with months of diarrhoea and weight loss: causes, work-up, and how do you decide that it is CMV colitis rather than mycophenolate?
Bottom line: split drug from infection. Mycophenolate is the commonest drug cause; C. difficile is the commonest bacteri...
A 52-year-old on haemodialysis is offered a deceased-donor kidney from a donation-after-circulatory-death donor with a high KDPI: how do you decide whether to accept it?
Bottom line: I classify the donor (DBD or DCD, controlled or uncontrolled), quantify donor quality with the KDPI (0 best...