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Interprets relapse risk based on ANCA specificity (PR3 vs MPO) and disease phenotype.

HPI & Summary Generator

EHR Helper

Generates a structured HPI, lab summary, and plan from unstructured clinical notes, tailored to your specialty.

Mainz Severity Score Index (MSSI)

Calculates severity of Fabry disease across general, neurological, cardiovascular, and renal domains.

Mehran Score for CIN

Predicts risk of contrast-induced nephropathy post-PCI.

APOL1 Genotyping Risk Assessment

Risk stratification based on G1/G2 risk alleles for FSGS, HTN-CKD progression, and donor evaluation.

ABCD² Score: Predicts the risk of stroke within 2 days after a TIA (Transient Ischemic Attack).

Calculators

The ABCD² score is a clinical prediction rule used to estimate the risk of stroke in the 2 days following a transient ischemic attack (TIA). It helps guide urgent management decisions and is based on Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes.

ABCD² Score: Predicts the risk of stroke within 2 days after a TIA (Transient Ischemic Attack).

Calculators

Bicarbonate Space Calculator

Estimates bicarbonate deficit for severe metabolic acidosis correction.

Make a Referral

EHR Helper

Writes a professional medical referral letter from one specialist to another based on key patient data.

Repeat Kidney Biopsy Decision Tool

Decision support for determining the utility of a repeat kidney biopsy in progressive disease.

Alport Genotype-Phenotype Correlation

Predicts renal prognosis and ESKD onset based on COL4A5 mutation type and inheritance pattern.

eGFR (CKD-EPI 2021 Creatinine)

CKD

Modern standard for staging chronic kidney disease (CKD) without race

Full House Immunofluorescence Interpreter

Identifies the diagnostic implications of a 'Full House' immunofluorescence pattern.

Urine Delta-Osmolarity

Electrolytes

Assesses ADH activity using Urine and Serum Osmolarity difference.

Contrast-Induced Nephropathy (CIN) Risk Score

Aki

Stratifies risk before contrast media exposure

Pauci-Immune Vasculitis Confirmator

Determines if immunofluorescence findings meet the criteria for Pauci-Immune GN.

Urine Sediment Score (Chawla/Perazella)

Grading system (0-4) utilizing RTEC and granular casts to predict AKI severity and non-recovery.

Urine:Plasma Creatinine Ratio

Acute Kidney Injury

Differentiates Pre-renal AKI from ATN using creatinine ratio.

EM Deposit Localizer

Differentiates glomerular diseases based on the location of electron-dense deposits.

EQUIL2 Supersaturation Program

Nephrolithiasis

Estimates urinary supersaturation of calcium oxalate, calcium phosphate, and uric acid from 24h urine parameters.

ESPEN Protein Requirement (CRRT)

Nutrition

Calculates daily protein target for ICU patients on CRRT per ESPEN guidelines.

NIH Stroke Scale (NIHSS) Calculator

Standardized assessment tool to quantify the impairment caused by a stroke.

Foot Process Effacement Analyzer

Distinguishes between Minimal Change Disease and Secondary FSGS based on effacement extent.

Modified NIH Stroke Scale (mNIHSS)

EHR Helper

A shortened version of the NIHSS with higher inter-rater reliability, excluding items 1a, 4, 7, and 10.

Urine Phosphorus-to-Protein Ratio

Nutrition

Nutritional tool to assess dietary phosphorus load and guide food choices to minimize phosphorus density.

Urine-to-Blood pCO2 Gradient

Acid Base

Diagnostic aid for Distal RTA (Type 1) assessing hydrogen ion secretion.

Urine pH (Post-Ammonium Chloride)

Acid Base

Definitive diagnostic test for Distal RTA (Type 1).

Topics (30)

PD Poor Drainage / Catheter Malfunction

"Instilled 2L, drained only 1L" is the classic PD stem — the examiner wants a stepwise mechanical-then-membrane approach: exclude catheter malposition/migration and omental wrapping with a KUB X-ray, treat constipation, try saline/heparin flush, escalate to intraluminal alteplase for fibrin, and only then consider intra-abdominal adhesions or EPS if the catheter position is normal and there is no response to flushing. A separate, equally high-yield stem is pain on DRAINING — a distinct entity from poor drainage: pain at the end of the drain phase as the catheter tip suctions against the parietal peritoneum or viscera once the cavity empties. The single answer the examiner is waiting for is TIDAL PD — leave a residual intraperitoneal volume (tidal volume typically set at 75-80% of the fill, so 20-25% stays in) so the catheter never runs dry — then reduce fill volume, extend the drain phase, treat constipation, warm the dialysate and use a neutral-pH low-GDP solution for inflow pain, and reposition or replace the catheter only if refractory.

IgA Nephropathy

Exam · Acute Kidney Injury

IgA nephropathy (IgAN) is the commonest primary GN worldwide and a favourite viva case for hematuria +/- proteinuria in a young adult. The examiner wants the MEST-C pathology score, the conservative-first pathway with the proteinuria threshold for escalation, and the new KDIGO 2024/2025 agents — SGLT2 inhibitors, sparsentan (dual endothelin/ARB), and Nefecon (targeted-release budesonide) — with their doses, trials and interactions.The 2025 escalation menu is wider again: atrasentan (Vanrafia, selective endothelin-A receptor antagonist, FDA accelerated approval April 2025, ALIGN) and sibeprenlimab (Voyxact, first-in-class anti-APRIL monoclonal antibody, FDA accelerated approval 25 November 2025, VISIONARY). The highest-yield examiner twist is the availability question — what you actually do when Nefecon and sparsentan are not on the formulary: maximal supportive care, then the KDIGO 2025 reduced-dose glucocorticoid regimen with antimicrobial prophylaxis, and MMF only as a glucocorticoid-sparing option in Chinese patients.

Hepatorenal Syndrome

Hepatorenal syndrome (HRS) is a functional AKI in a patient with cirrhosis and ascites, a diagnosis of exclusion made when creatinine fails to improve after albumin infusion and diuretic withdrawal, with no shock, nephrotoxins, or structural kidney disease. The examiner wants albumin plus a vasoconstrictor (terlipressin, or noradrenaline / midodrine+octreotide), a clear explanation of why dialysis is not the answer — RRT does not treat the circulatory dysfunction and gives no survival benefit in a patient who is not a transplant candidate, so it is a bridge and the decision turns on transplant candidacy, not the creatinine — and recognition that the definitive treatment is liver transplantation. Have the MELD score (bilirubin, INR, creatinine; MELD-Na adds sodium, MELD 3.0 adds albumin and sex) ready, and frame HRS-AKI as a diagnosis of exclusion using the ICA criteria.

Hemodiafiltration (HDF) — CONVINCE

Hemodiafiltration (HDF) combines diffusion (as in standard HD) with high-volume convection using replacement fluid, giving superior clearance of middle molecules like beta-2 microglobulin. The examiner wants the mechanism, the eligibility criteria (good vascular access, blood flow >300-350 mL/min, adequate cardiovascular reserve, ability to achieve high substitution volume >22.5-23 L/session), and the supporting evidence — the CONVINCE trial showing a mortality reduction of roughly 23% with high-volume HDF. The two things candidates most often miss are (1) the named trial sequence — CONTRAST (2012, neutral), the Turkish OL-HDF Study, Ok et al. (2013, neutral primary endpoint but a post-hoc benefit confined to the high-convection subgroup — the reason convection volume became the target at all), ESHOL (2013, positive) and then CONVINCE (2023) — and (2) how the convection volume is actually calculated and prescribed: post-dilution total convection volume = substitution volume + net ultrafiltration, driven by blood flow × filtration fraction × treatment time, with the filtration fraction capped at about 20-25% of blood flow to avoid haemoconcentration and filter clotting; pre-dilution escapes that cap but needs roughly double the volume for the same clearance.

PD Catheter Exit-Site / Friable Bleeding Mass

A friable, bleeding mass at the PD catheter exit site is a recurring, deliberately open-ended viva question — the examiner is testing your reasoning process, not whether you blurt one diagnosis. The classic answer is exit-site granulation tissue (pyogenic-granuloma-like), presenting with pus, crusting, and blood, but you must also work through exit-site/tunnel infection, calciphylaxis, and skin malignancy as differentials, and know that blood on the dressing soon after catheter insertion is normal, whereas late bleeding needs the same work-up as bloody effluent.

Membranous Nephropathy / anti-PLA2R

Membranous nephropathy (MN) is the commonest exam cause of adult nephrotic syndrome. The examiner wants: a workup of nephrotic proteinuria, the role of anti-PLA2R (positive >20 IU/mL = primary; no biopsy needed to start therapy unless rapid GFR decline), KDIGO risk stratification (low / moderate / high / very high), and a rituximab-first immunosuppression plan with the trial names. Keywords: anti-PLA2R, >50% proteinuria drop at 6 months, rituximab, MENTOR, primary vs secondary.

Intradialytic Hypertension (IDHTN)

Intradialytic hypertension is a paradoxical rise in blood pressure during or immediately after hemodialysis, and unlike IDH it is under-recognized but carries independent mortality risk. The examiner wants the mechanisms — volume overload/inadequate ultrafiltration is the most common — followed by sympathetic and RAAS activation, endothelial dysfunction (low nitric oxide, high endothelin-1), high dialysate sodium, EPO therapy, and removal of antihypertensive medication by dialysis, then a management plan built around optimizing dry weight.

Hematuria / Proteinuria Approach (and Renal Mass)

Hematuria and proteinuria are the commonest presenting-complaint viva stems. The examiner wants a confirm-then-localize approach: confirm hematuria on a second sample, exclude transient causes, then separate glomerular (dysmorphic RBCs, RBC casts, proteinuria) from urological/non-glomerular bleeding. Isolated proteinuria needs quantification (24h or PCR) before labeling benign. Hematuria plus rising creatinine is a nephritic emergency; family history plus hematuria/high creatinine should trigger an atypical/familial HUS workup. A renal mass found during hematuria workup pivots the discussion to renal cell carcinoma.

Filtration Fraction / Filter Clotting

Exam · CRRT / ICU

Filtration fraction (FF) is the fraction of plasma flow removed as ultrafiltrate during CRRT: FF = UF rate / plasma flow, where plasma flow = blood flow (Qb) x (1 - hematocrit). Keeping FF under 20-25% is the key lever to prevent hemoconcentration in the filter and reduce filter clotting — a practical, numbers-heavy CRRT-prescription question the examiner uses to test bedside troubleshooting.

Encapsulating Peritoneal Sclerosis (EPS)

Encapsulating peritoneal sclerosis (EPS) is a rare but feared late complication of long-term PD in which a thick fibrocollagenous membrane encases and tethers the bowel loops, causing recurrent sub-obstruction/obstruction. The examiner wants you to recognize the classic triggers (long PD duration >5 years, recurrent peritonitis, high-transporter status, prolonged hypertonic glucose exposure), the presentation (abdominal pain, weight loss, bowel obstruction, bloody effluent, ultrafiltration failure — usually WITHOUT active peritonitis), and a management ladder from stopping PD to surgical enterolysis.

RPGN / Crescentic GN (ANCA, Anti-GBM, Immune-Complex)

RPGN is defined by rapid loss of kidney function over days to weeks with crescents on biopsy. The examiner's ladder is: eliminate an urgent dialysis indication first, send full immunology (ANCA, anti-GBM, ANA/dsDNA, C3/C4, hepatitis serology), and classify into type I anti-GBM (linear IF, all crescents same stage), type II immune-complex (lupus, post-infectious, MPGN, granular IF), or type III pauci-immune ANCA (PR3/MPO, crescents in different stages). If biopsy cannot be done promptly, start empiric immunosuppression as for ANCA vasculitis. Treatment is pulse steroids + cyclophosphamide or rituximab for ANCA (avacopan as steroid-sparing, 2023), and plasmapheresis + steroids + cyclophosphamide for anti-GBM/Goodpasture, especially with pulmonary hemorrhage.

Dialysis Water Treatment System

The dialysis water treatment system is a recurring 'systems' question — the examiner wants the components in order (sediment/carbon filter, heavy-metal filter, softener, reverse osmosis, deionizer, bacterial/endotoxin filter, giving ultrapure water) and the specific contaminants and their complications — aluminium (encephalopathy, bone disease), chloramine (hemolysis), endotoxin (pyrogenic reactions, TMA), copper, and fluoride.

UTI / Pyelonephritis / Vaccination

Exam · Acute Kidney Injury

The reported exam stem is a young woman with recurrent UTI. The examiner wants a structured workup (confirm true recurrence with cultures, screen for risk factors, image for structural/functional causes) and a clear prophylaxis ladder (behavioral measures first, then post-coital or continuous low-dose antibiotics). Vaccination status (pneumococcal, hepatitis B, influenza) is also expected knowledge for CKD/dialysis/transplant patients prone to infection.

Transplant Tourism / Declaration of Istanbul

Exam · Transplant

Transplant tourism is travelling abroad to buy an organ (commercial/unrelated donor) outside a regulated program. The examiner wants a supportive, non-judgmental counselling approach, recognition of the medical and ethical risks, knowledge of the Declaration of Istanbul, and a practical pre-/post-travel safety plan — plus safe management of the patient who returns unwell.

HUS / TMA / TTP

Thrombotic microangiopathy (TMA) presents with the triad of microangiopathic hemolytic anemia (schistocytes, high LDH, low haptoglobin), thrombocytopenia, and AKI. The examiner wants you to separate STEC-HUS, atypical/complement-mediated HUS, TTP (ADAMTS13 <10%), and secondary TMA, then move quickly to plasma exchange or eculizumab while assessing dialysis needs early.

T-cell Mediated (Cellular) Rejection

Exam · Transplant

T-cell mediated rejection (TCMR) is the classic cellular rejection question in the viva. The examiner wants the Banff grading system (borderline through III) recited precisely, the pathognomonic histology (tubulitis + interstitial inflammation, no C4d/DSA), and grade-specific treatment — pulse steroids for mild grades, ATG for severe grades — with confident handling of the classic 10-month, stage IIb case.

Kidney Stones — Approach & Metabolic Workup

Exam · Tubular & Stones

Renal colic and recurrent nephrolithiasis are the most reliable stone cases in the viva. The examiner wants a structured approach (history → exam → stone-protocol non-contrast CT → stone-type differentiation → 24h metabolic screen), safe analgesia, and — for the 17-18yo recurrent-stone stem — recognition of distal renal tubular acidosis type 1 (low bicarbonate, hypokalemia, nephrocalcinosis) with Bartter syndrome as the key differential.

Metabolic Acidosis in CKD — Bicarbonate & Diet

Exam · CKD & Bone-Mineral

Metabolic acidosis in CKD is a normal-anion-gap (non-AG) acidosis from impaired renal ammoniagenesis and acid excretion as nephron mass falls. The examiner wants the pathophysiology explained precisely, then the evidence-based non-pharmacological management (low-protein/plant-based alkaline diet) alongside bicarbonate therapy, plus awareness that this topic is often chained into C3 glomerulonephritis → paraproteinemia and intradialytic hypotension follow-ups.

Renal Biopsy — Indications & Complications

Exam · Acute Kidney Injury

Renal biopsy is a core diagnostic-procedure viva case. The examiner wants clean lists — indications (unexplained AKI/CKD, nephrotic/nephrotic-range proteinuria, systemic disease, transplant dysfunction), contraindications (bleeding tendency, uncontrolled BP, Hb <7, small kidneys), and precise pre-biopsy bleeding-reduction measures — then a structured plan for the classic complication, hematoma, escalating to angiography and embolization.

Antibody-Mediated Rejection (ABMR)

Exam · Transplant

Antibody-mediated rejection (ABMR) is the classic transplant viva: rising creatinine in a kidney-transplant recipient with a biopsy showing microvascular inflammation. The examiner wants the Banff diagnostic triad (microvascular inflammation g+ptc, C4d in PTC or molecular ENDAT, and a donor-specific antibody), then treatment in order with doses (pulse steroids → plasmapheresis → IVIG → rituximab), and the trap of commercial transplant with an unknown donor (do not say 'donor-specific antibody'). Refer refractory cases to a tertiary centre.

Renal Tubular Acidosis (RTA)

Exam · Tubular & Stones

Renal tubular acidosis (RTA) is a normal-anion-gap (hyperchloremic) metabolic acidosis from a tubular defect in acid handling. The examiner wants you to name the three clinical types (I distal, II proximal, IV hypoaldosteronism), state the urine pH and potassium pattern that separates them, name the classic causes/associations, and give the specific treatment of each — then explain how untreated RTA progresses to nephrocalcinosis, stones, and CKD/ESRD.

Rhabdomyolysis

Rhabdomyolysis is muscle breakdown releasing myoglobin, CK, potassium, and phosphate into the circulation, causing AKI. The classic exam vignette is a patient collapsed in the desert (exertional/heat-related), and the examiner wants rapid recognition — markedly elevated CK, myoglobinuria (dipstick blood-positive with no RBCs on microscopy) — followed by aggressive fluid resuscitation, hyperkalemia treatment, and watching for compartment syndrome.

Dialysis (CKD-Associated) Pruritus

CKD-associated pruritus (CKD-aP) is common in dialysis patients and the exam favourite twist is naming difelikefalin, a kappa-opioid receptor agonist, and being able to state its mechanism of action when the examiner probes further. The core answer is a stepwise approach: optimize dialysis adequacy and mineral bone disease control first, then topical/emollient measures, then systemic agents (gabapentin/pregabalin, antihistamines, UVB phototherapy), and finally difelikefalin for refractory moderate-to-severe pruritus.

Kidney Disease in Pregnancy — Pre-eclampsia, Lupus, IgA

Kidney disease in pregnancy spans pre-eclampsia (new hypertension ≥20 weeks + proteinuria/organ dysfunction), safe antihypertensive choices (labetalol, nifedipine, methyldopa; avoid ACEi/ARB), intensive hemodialysis prescriptions, and complex counseling for lupus nephritis/antiphospholipid syndrome around conception. The examiner probes definitions, BP targets, biopsy timing, and pre-conception drug switching.

Pheochromocytoma / Renal Artery Stenosis

Exam · Hypertension

Pheochromocytoma presents with the classic triad of episodic headache, palpitations, and diaphoresis on a background of labile or paroxysmal hypertension. The examiner's single most important keyword is the treatment sequence: alpha-blockade BEFORE beta-blockade — giving a beta-blocker first can precipitate an unopposed alpha crisis with severe hypertension and pulmonary edema. Diagnosis rests on plasma or 24h urinary fractionated metanephrines, followed by CT/MRI adrenal imaging, with surgery as definitive treatment after adequate alpha-blockade.

PD Ultrafiltration Failure

Ultrafiltration (UF) failure is defined as failure to achieve adequate net UF despite using the maximum hypertonic (4.25%) glucose exchange, and is a leading cause of technique failure in PD. The examiner wants you to classify it (Type I high transporter/aquaporin dysfunction, Type II low effective surface area, Type III high lymphatic absorption, Type IV free-water transport), confirm it with the (modified) PET test, and manage with icodextrin, shorter dwells, and preservation of residual renal function — always first excluding mechanical catheter problems.

PD Peritonitis (ISPD)

PD peritonitis is the single most-asked PD case in the viva (the examiner drills diagnosis, exact empiric intraperitoneal antibiotics, duration by organism, and the indications for catheter removal). The examiner waits for three keywords: cloudy effluent, effluent WBC >100 with >50% neutrophils, and intraperitoneal vancomycin + ceftazidime. He will then escalate: fungal? refractory? when do you pull the catheter? Anchor every answer on ISPD 2022.

PD Volume Overload / APD Overload

Fluid overload a few months into PD (classically APD with a dry day) is a very testable stem. The examiner wants you to work through the causes systematically — UF failure, catheter dysfunction/leak, dietary indiscretion, and loss of residual renal function — confirm membrane status with a modified PET, and manage by optimizing the prescription (icodextrin for the long/day dwell, higher glucose strength, salt/water restriction) while protecting residual renal function and targeting an adequate Kt/V (≥1.7 weekly total, individualized).

Nephrotic Syndrome (General & VTE)

Nephrotic syndrome is the generic gateway case before the examiner narrows to a specific glomerulopathy. Expect a heavy-proteinuria, hypoalbuminemic patient with edema who then develops sudden leg swelling or dyspnea — the examiner is testing whether you recognize venous thromboembolism / renal vein thrombosis as the feared complication, know the albumin threshold for anticoagulation, and can run through causes, edema mechanism, and initial management before naming the underlying glomerulopathy.

Dialysis Modality Choice (HD vs PD)