MBBS OSCE · General Medicine
OSCE — Drug Dosing in Kidney Disease
Eight-minute OSCE station on Drug Dosing in 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 Drug Dosing in Kidney Disease.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Drug dosing in kidney disease is the systematic discipline of estimating kidney function, reviewing every drug, adjusting the dose or interval, avoiding nephrotoxins, monitoring levels, and reassessing at every visit — the two commonest preventable errors are not adjusting a renally-cleared drug (toxicity) and missing a nephrotoxin that worsens kidney function (AKI). Estimate function with Cockcroft-Gault (for dosing) or eGFR CKD-EPI (for staging); both are invalid during AKI. Dose-adjust: vancomycin, aminoglycosides, beta-lactams, gabapentin/pregabalin, digoxin, DOACs, allopurinol. Avoid/caution: NSAIDs, iodinated contrast, ACEi/ARB in volume depletion; nitrofurantoin under 30, lithium, met
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- 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 | AKI developing on a renally-cleared drug - stop or reduce; reassess dosing immed |
| Safety | NSAIDs, iodinated contrast or ACE inhibitor given in AKI or volume depletion - n |
| Safety | Metformin continued at eGFR under 30 - lactic acidosis risk; stop; do not initia |
| 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.