MBBS OSCE · General Medicine
OSCE — Rapidly Progressive Glomerulonephritis
Eight-minute OSCE station on Rapidly Progressive Glomerulonephritis: 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 Rapidly Progressive Glomerulonephritis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Rapidly progressive glomerulonephritis (RPGN) is the most aggressive form of glomerulonephritis and a true renal emergency: a syndrome of rapid loss of renal function (loss of over 50 per cent of GFR within under 3 months), unified by the histological hallmark of crescents — fibrin and proliferating parietal epithelial cells — in Bowman's space. Untreated it progresses to end-stage kidney disease within weeks. It is classified by immunofluorescence into three types: Type I anti-GBM (linear IgG; Goodpasture syndrome with pulmonary haemorrhage), Type II immune-complex (granular; lupus, post-infectious, IgA) and Type III pauci-immune (ANCA-associated vasculitis — GPA, microscopic polyangiitis;
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 | Rapidly rising creatinine with haematuria and RBC casts — crescentic GN; start h |
| Safety | Haemoptysis with rapidly progressive GN — pulmonary-renal syndrome (Goodpasture |
| Safety | Anti-GBM-positive disease with falling GFR — emergency plasma exchange plus meth |
| 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.