MBBS OSCE · Nephrology / General Medicine
OSCE — diabetic CKD staging and disease-modifying therapy
OSCE on KDIGO G/A staging, ACEI/ARB + SGLT2i with trial names, anaemia Hb targets, and emergency hyperkalaemia management with calcium gluconate and insulin-glucose doses.
8 min stationSource-verified ·
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Exam tags
NEET-PGINICETUSMLEPLAB
Brief (to candidate)
A 58-year-old man with T2DM has eGFR 38 mL/min/1.73 m² (stable 8 months) and UACR 420 mg/g. BP 148/88 on amlodipine alone. Second prompt: K⁺ 7.1 with peaked T waves. 8 minutes.[1]
Candidate instructions
- Define CKD and state KDIGO G3b A3.
- Start/titrate ACEI/ARB, add SGLT2i (dapagliflozin 10 mg or empagliflozin 10 mg), BP target, statin.[1]
- Anaemia: iron first; ESA Hb target 100–120 g/L, avoid >130.[1]
- Hyperkalaemia sequence: calcium gluconate 10 mL 10% IV → insulin 10 U + glucose → salbutamol → remove K⁺/dialysis.[1]
- Nephrology referral triggers and sick-day rules (hold ACEI/SGLT2i if severe dehydrating illness per local advice).[1]
Examiner checklist
| Domain | Expected |
|---|---|
| Staging | >3 months; G and A categories |
| DM CKD Rx | RAAS blockade + SGLT2i evidence (DAPA-CKD/EMPA-KIDNEY/CREDENCE) |
| Monitoring | K⁺, creatinine after ACEI; avoid dual RAAS |
| HyperK | Correct drug/dose/order |
| Complications | MBD, volume, acidosis, CV risk |
| Communication | Explain progressive nature; RRT options later |
Common errors
- Dual ACEI+ARB.[1]
- ESA to normalise Hb fully.
- Insulin without glucose monitoring plan.
Model key actions
- G3bA3 diabetic CKD: ACEI/ARB + SGLT2i (dapagliflozin 10 mg or empagliflozin 10 mg) + statin + BP target usually under 130/80.[1]
- Check K and creatinine 1 to 2 weeks after RAAS start; never dual ACEI+ARB.[1]
- Anaemia: replete iron; ESA target Hb about 100 to 120 g/L.[1]
- HyperK with ECG changes: calcium gluconate then shift (insulin-glucose, salbutamol) then remove (binders/dialysis).[1]
Common errors
- Normalising Hb with ESA above 130 g/L.[1]
- Ignoring albuminuria when eGFR only mildly reduced.
- Delaying calcium in ECG-positive hyperkalaemia.
References4ShowHide
- [1]Levin A, Ahmed SB, Carrero JJ, et al. Executive summary of the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int, 2024.PMID 38519239
- [3]Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med, 2019.PMID 30990260
- [4]Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med, 2020.PMID 32970396
- [5]Herrington WG, Staplin N, Wanner C, et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med, 2023.PMID 36331190