MBBS OSCE · Nephrology
OSCE — Renal Replacement Therapy
Eight-minute OSCE station on Renal Replacement Therapy: 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 Renal Replacement Therapy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Renal replacement therapy (RRT) is the substitution of the kidney's excretory, fluid-balance and electrolyte/acid-base functions when they fail — applied either as planned maintenance therapy in end-stage kidney disease (ESKD) or as emergency support in severe acute kidney injury (AKI). There are three modalities — haemodialysis (HD) (extracorporeal clearance across a semipermeable membrane by diffusion; AV fistula is the best access, 3 times weekly, target Kt/V over 1.2; risks access infection, intradialytic hypotension, amyloidosis), peritoneal dialysis (PD) (the peritoneal membrane as the filter, glucose osmotic gradient, home-based, gentler; main risk peritonitis, usually *Staph epidermi
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 | ESKD/AKI patient with refractory hyperkalaemia (K over 6.5 with ECG changes), se |
| Safety | Peritoneal dialysis patient with cloudy effluent and abdominal pain — PD periton |
| Safety | Transplant recipient with fever, graft tenderness or rising creatinine — rejecti |
| 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.