MBBS OSCE · General Medicine
OSCE — Diabetic Kidney Disease
Eight-minute OSCE station on Diabetic Kidney Disease: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Diabetic Kidney Disease. [1] You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Diabetic kidney disease (DKD, diabetic nephropathy) is the commonest single cause of end-stage kidney disease (ESKD) worldwide, developing over years through a predictable pathway of glomerular hyperfiltration, microalbuminuria, macroproteinuria and declining GFR. Its histological hallmark is nodular glomerulosclerosis (Kimmelstiel-Wilson nodules) with thickening of the glomerular basement membrane and mesangial expansion, driven by chronic hyperglycaemia and intraglomerular hypertension. The earliest clinical marker is albuminuria measured as the urine albumin-to-creatinine ratio (UACR): screen annually from diagnosis in type 2 diabetes and from 5 years after diagnosis in type 1 diabetes. R [1]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms. [1]
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Diabetic with new albuminuria — confirm with UACR and start ACE inhibitor/ARB at |
| Safety | Rapidly declining GFR, haematuria, short diabetes duration or absent retinopathy |
| Safety | Diabetic on an SGLT2 inhibitor with nausea, vomiting, abdominal pain and metabol |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging. [1]
References2ShowHide
- [1]de Boer IH, Khunti K, Sadusky T, et al. Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Care, 2022.PMID 36189689
- [2]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