Nephrology
Acute kidney injury, chronic kidney disease, electrolyte disorders and glomerular disease. Questions test safe correction of electrolytes and nephroprotection.
High-yield points
AKI (KDIGO): creatinine rise of 26.5 umol/L or more in 48 hours, or 1.5x baseline in 7 days, or low urine output; stop nephrotoxins (NSAIDs, ACE inhibitors, diuretics, metformin) and look for obstruction.
CKD is staged by both eGFR and urine albumin-creatinine ratio (uACR); check both in people at risk.
Nephroprotection: BP control, ACE inhibitor or ARB for albuminuria, SGLT2 inhibitor, and stop smoking.
Hyperkalaemia with ECG changes: IV calcium gluconate 10% to stabilise the myocardium, then insulin-dextrose and salbutamol to shift potassium, then remove it.
Hyponatraemia: assess volume status; correct chronic hyponatraemia by no more than 8-10 mmol/L in 24 hours to avoid osmotic demyelination.
Nephritic syndrome (haematuria, hypertension, oedema) after skin or throat infection suggests post-streptococcal glomerulonephritis.
Nephrotic syndrome: proteinuria over 3.5 g/day, hypoalbuminaemia, oedema; watch for VTE and infection.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Units | Creatinine in mg/dL. | Creatinine in umol/L; eGFR (CKD-EPI) reported automatically; albuminuria as urine albumin:creatinine ratio (uACR). |
| Who gets CKD | Diabetes, hypertension, glomerulonephritis, and CKD of unknown cause in some regions. | Diabetes and hypertension lead. Aboriginal and Torres Strait Islander people have far higher kidney failure rates. |
| Detecting CKD | Usually found when symptomatic or on routine tests. | Kidney Health Check (BP, eGFR, uACR) every 1-2 years for at-risk people in general practice. |
| Access to dialysis | Cost is a major barrier; free dialysis in public hospitals under national schemes. | Publicly funded; home dialysis encouraged. Remote patients often have to relocate for dialysis, a real cultural and social burden. |
Units
India (MBBS)
Creatinine in mg/dL.
Australia (AMC): what the exam expects
Creatinine in umol/L; eGFR (CKD-EPI) reported automatically; albuminuria as urine albumin:creatinine ratio (uACR).
Who gets CKD
India (MBBS)
Diabetes, hypertension, glomerulonephritis, and CKD of unknown cause in some regions.
Australia (AMC): what the exam expects
Diabetes and hypertension lead. Aboriginal and Torres Strait Islander people have far higher kidney failure rates.
Detecting CKD
India (MBBS)
Usually found when symptomatic or on routine tests.
Australia (AMC): what the exam expects
Kidney Health Check (BP, eGFR, uACR) every 1-2 years for at-risk people in general practice.
Access to dialysis
India (MBBS)
Cost is a major barrier; free dialysis in public hospitals under national schemes.
Australia (AMC): what the exam expects
Publicly funded; home dialysis encouraged. Remote patients often have to relocate for dialysis, a real cultural and social burden.
The Australian context
Australia reports creatinine in umol/L. Aboriginal and Torres Strait Islander people have far higher rates of kidney failure, often from diabetes and past post-streptococcal glomerulonephritis, and many remote patients must relocate to access dialysis, which is a recognised cultural and social burden.