MBBS OSCE · General Medicine
OSCE — Membranous Nephropathy & FSGS
Eight-minute OSCE station on Membranous Nephropathy & FSGS: 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 Membranous Nephropathy & FSGS.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Membranous nephropathy and focal segmental glomerulosclerosis (FSGS) are the two commonest primary glomerular causes of nephrotic syndrome in adults. Membranous nephropathy is an antibody-mediated subepithelial immune-complex disease: in 70 to 80% it is primary, driven by IgG4 autoantibodies against the podocyte M-type phospholipase A2 receptor (PLA2R) (and rarely THSD7A); secondary forms arise from solid-organ malignancy, hepatitis B and C, lupus class V, NSAIDs/gold/penicillamine, syphilis and thyroid disease. It carries the highest thrombotic risk of any nephrotic cause (renal vein thrombosis), and about a third remit spontaneously (the rule of thirds). FSGS is a podocytopathy defined his
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 | Nephrotic syndrome in an adult - biopsy; commonest primary causes are membranous |
| Safety | Membranous nephropathy with serum albumin under 25 g/L - very high thrombosis ri |
| Safety | New membranous nephropathy in an adult over 50 - mandatory malignancy screen and |
| 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.