Typical exam stem
A patient has eGFR 38 mL/min/1.73 m² and persistent albuminuria. How would you classify, investigate and manage the CKD?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
How is CKD defined?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Define chronicity and classify risk
CKD requires persistent abnormal kidney structure or function with implications for health. A single reduced eGFR during acute illness does not establish CKD. Use both GFR category and albuminuria category because prognosis depends on both dimensions.
Assess cause and complications
- History: diabetes, hypertension, vascular disease, recurrent infection, obstruction, inherited disease and nephrotoxic exposure.
- Urinalysis and urine albumin measurement help distinguish glomerular from non-glomerular patterns.
- Ultrasound when structural disease, obstruction, inherited disease or advanced CKD is suspected.
- Screen for anaemia, hyperkalaemia, acidosis, mineral-bone disorder, volume overload and cardiovascular disease according to stage and risk.
Management goals
Treat the underlying cause, control blood pressure, reduce albuminuria where possible, optimise diabetes management and use evidence-based kidney-protective therapies when indicated. Avoid nephrotoxins, adjust drug doses and address cardiovascular risk. Vaccination, dietary advice and preparation for kidney replacement therapy become increasingly important as disease advances.
Referral is guided by rapid progression, heavy albuminuria, difficult hypertension, uncertain cause, recurrent electrolyte disturbance, advanced CKD or complications requiring specialist management.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.