Morning Rounds · Nephrology Series
Nephrology
A Guide to the Morning Rounds Series
A Guide to the Morning Rounds Series
Seven high-yield rounds · 35 clinical cases · NEET-PG and UPSC CMS · +4 / −1 scoring
Nephrology sits at a peculiar crossroads in medical examinations — it is simultaneously one of the most physiologically demanding subjects and one of the most formula-dependent. A question on RTA type I can be answered by pure logic if you understand tubular acid-base physiology. A question on KDIGO staging requires knowing a number. This series tries to honour both demands without letting either crowd out the other.
For the practising physician, nephrology is never purely theoretical. It is the diabetic man whose creatinine has crept up silently for years, the young woman with foamy urine and ankles the size of mangoes, the child post-diarrhoeal illness who stops urinating, the dialysis patient who comes in altered — and the first question is always whether the machine or the potassium is responsible. These seven rounds are built from those patients.
The sequence below follows a logical clinical arc — from acute to chronic, structural to functional, medical to interventional. Each round is five cases with full debrief panels and SVG diagrams where a visual anchors understanding better than prose. Take them in order or as revision demands.
The Seven Rounds
Round 01 · Nephrology Series
Acute Kidney Injury
The full clinical arc of AKI from staging to emergency management. Covers RIFLE versus KDIGO criteria with the 2× creatinine and urine output thresholds, the pre-renal versus ATN distinction using FENa (formula, calculation, and the critical caveat on diuretics), post-surgical ATN with muddy brown casts on microscopy, the AEIOU indications for urgent RRT with a multi-indication vignette, and contrast-induced AKI with the landmark PRESERVE trial finding that NAC offers no benefit over hydration alone. Includes SVG diagrams for both RIFLE/KDIGO staging and FENa interpretation.
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Round 02 · Nephrology Series
Chronic Kidney Disease
CKD from the first abnormal creatinine to the dialysis decision. Covers KDIGO 2012 staging with eGFR and albuminuria categories (the heat-map grid, G3b A2 versus G3a, duration criterion), CKD-mineral bone disorder with the secondary hyperparathyroidism mechanism and phosphate binder rationale, slowing progression with the SGLT2 inhibitor evidence from CREDENCE and DAPA-CKD alongside RAS blockade — and why dual blockade is contraindicated (ONTARGET), anaemia management with the iron-first principle before ESA, IV iron preference in dialysis, and the Hb ceiling at 12 g/dL from the CHOIR and CREATE trials, and the IDEAL trial finding that early RRT initiation offers no survival advantage. Includes the CKD staging and anaemia pathway SVG diagrams.
Open Round →
Round 03 · Nephrology Series
Glomerular Diseases
The nephrotic-nephritic framework applied to five distinct clinical presentations. Covers nephrotic syndrome in a child with the MCD diagnosis-without-biopsy principle and podocyte foot process effacement on EM, IgA nephropathy with the synpharyngitic haematuria timing that distinguishes it from post-streptococcal GN's latent period and the role of normal complement, membranous nephropathy with anti-PLA2R as the primary/secondary discriminator and rituximab as the modern treatment, anti-GBM disease (Goodpasture) with the pulmonary-renal syndrome, linear IgG on IF, and the nuanced plasma exchange indication in anuric patients, and lupus nephritis Class IV with wire-loop lesions, MMF versus cyclophosphamide induction, and the ISN/RPS classification table. Includes the nephrotic-nephritic comparison SVG and the ISN/RPS class diagram.
Open Round →
Round 04 · Nephrology Series
Renal Tubular Disorders
Five cases in tubular physiology — the most logic-intensive round in the series. Covers Type I RTA with its Sjögren association, hypokalaemia, urine pH fixed above 5.5, and nephrocalcinosis as the radiological signature, Fanconi syndrome from tenofovir with generalised proximal tubular wasting including normoglycaemic glycosuria, hypophosphataemia, and aminoaciduria, the Bartter versus Gitelman distinction pivoting on calcium (hypercalciuria vs hypocalciuria + hypomagnesaemia), Type IV RTA in a diabetic on an ACE inhibitor with the hyporeninism-hypoaldosteronism mechanism and the urine pH below 5.5 that separates it from Type I, and nephrogenic diabetes insipidus from lithium with the AQP2 mechanism, DDAVP test interpretation, and the paradoxical treatment with thiazides. Includes the full RTA comparison SVG.
Open Round →
Round 05 · Nephrology Series
Electrolytes — The Renal Lens
Electrolyte disorders examined through the kidney's role in their genesis and correction. Covers SIADH from sertraline with the diagnostic criteria, urine sodium and osmolality pattern, fluid restriction as first-line, and the 8 mEq/L/day correction ceiling with ODS as the price of overcorrection, hypernatraemia from insensible losses in an elderly nursing-home patient with the free-water deficit formula and the 0.5 mEq/L/hour correction ceiling, hyperkalaemia management with the C-B-D-E-R sequence and the primacy of calcium gluconate for membrane stabilisation when ECG changes are present, hypokalaemia with renal potassium wasting from primary hyperaldosteronism (Conn) — suppressed renin, elevated aldosterone, the aldosterone:renin ratio, and adrenal vein sampling — and metabolic alkalosis classified by urine chloride with the chloride-responsive versus resistant distinction and isotonic saline as treatment. Includes the hyponatraemia diagnostic algorithm SVG and the hyperkalaemia ECG progression diagram.
Open Round →
Round 06 · Nephrology Series
Dialysis & Transplantation
Renal replacement therapy in its clinical entirety. Covers the HD versus PD choice with residual renal function preservation as PD's physiological advantage, the Tenckhoff catheter and home-based autonomy, intra-dialytic hypotension as the commonest HD complication with the ultrafiltration-refilling mismatch mechanism and sodium profiling as prevention, PD peritonitis with the 100 WBC threshold, empirical intraperitoneal vancomycin plus ceftazidime, and catheter removal indications including fungal peritonitis, acute cellular rejection at day 10 post-transplant with tubulitis on biopsy, the negative crossmatch excluding hyperacute rejection, and pulse methylprednisolone as treatment, and PTLD as an EBV-driven B-cell proliferation with reduction of immunosuppression as the first step before rituximab. Includes the transplant rejection types comparison SVG.
Open Round →
Round 07 · Nephrology Series
Hereditary, Vascular & Structural Nephrology
The series closer, covering the structural and vascular renal diseases that span genetics, radiology, and emergency medicine. ADPKD in two linked cases — PKD1 versus PKD2 with the autosomal dominant inheritance and tolvaptan from the TEMPO trial, then the extrarenal manifestations with berry aneurysm screening logic for a pilot with a family history of subarachnoid haemorrhage. Fibromuscular dysplasia in a young woman with the string-of-beads sign, PTA without stenting as treatment, and the ASTRAL/CORAL trial evidence against stenting in atherosclerotic RAS. Malignant hypertension with papilloedema, schistocytes, MAHA, and the critical 20–25% MAP reduction rule in the first hour to prevent cerebral hypoperfusion. STEC-HUS in a child following a diarrhoeal illness, with antibiotic avoidance as the pivotal management principle, and the HUS versus TTP distinction on ADAMTS13, dominant organ, and plasma exchange indication. Includes the ADPKD extrarenal map SVG and the HUS-TTP comparison table.
Open Round →
Topics not covered in this series
This series is thorough but not encyclopaedic. Areas of nephrology outside these seven rounds include urinary tract infections and pyelonephritis in full surgical and microbiological depth, renal calculi with metabolic workup and stone-specific treatment, obstructive uropathy and its surgical management, renal pharmacology and drug dosing in CKD (covered in dedicated Bolus sessions on atsixty.com), Alport syndrome and thin basement membrane disease, and the paediatric nephrotic syndrome beyond MCD — including congenital nephrotic syndrome of the Finnish type — which is more naturally addressed in a dedicated Paediatric series.
A note for doctor-examinees
Nephrology is one of those subjects where examination questions cluster around a small number of deeply consequential clinical decisions — when to correct sodium, which RTA from a urine pH, why not to give antibiotics in HUS. The cases in this series are built around those moments. If any question seems off-pitch — clinically inaccurate, pitched at the wrong level, or missing a nuance that matters — the contact page is open. Good feedback makes every subsequent round sharper.
Morning Rounds · atsixty.com · Seven rounds · 35 high-yield clinical cases · +4 / −1 scoring · NEET-PG and UPSC CMS