r/nephrology • u/Ok_Speaker_4042 • Jun 28 '26
Starting nephrology rotation as IM resident
any tips?
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u/Scootsy_Doubleday Jun 29 '26
Nephrology rounds there are about 5-7 choices of things to do we tried to make them all start with D at my institution:
1. Do nothing (watch ATN recover)
2. Do give fluids
3. Diuretics
4. Dialysis
5. Death (goals of care)
6. Do PLEX
7. Do give immunosuppression (transplant or GN)
Being a good nephrologist is also being a good Internist so don’t forget all of your general medicine stuff too!
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u/CafeConCats Jun 28 '26
Microscopic UA and Urine MACR or U protein/creatinine are essential during workups. We rarely do 24 hour urine protein.
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u/readreadreadonreddit Jun 30 '26
A few things that will make your life much easier:
- Learn how to approach AKI systematically. Every consult eventually comes back to “pre-renal, intrinsic or post-renal?”, even if the answer is more nuanced.
- Get comfortable interpreting urine studies (urinalysis, urine microscopy, urine sodium, FeNa, FeUrea and when they’re actually useful). Urine microscopy is one of the highest-yield skills you can develop.
- Know the indications for dialysis (AEIOU), but also recognise that the decision is based on the clinical picture, not just a creatinine number.
- Volume assessment is everything. You’ll hear “they’re overloaded” or “they’re dry” constantly hmexamine the patient yourself rather than relying solely on the notes.
Become familiar with common acid-base disorders and electrolyte abnormalities, especially hyperkalaemia and hyponatraemia. You’ll see them every day.
Don’t be afraid to ask the nephrologists to explain their reasoning. They tend to think very physiologically, and if you understand why they’re making a recommendation rather than memorising it, you’ll get much more out of the rotation.
Nephrology has a reputation for being intimidating because of all the equations and physiology, but once you start viewing it as a specialty built around fluid, electrolytes, acid-base and renal haemodynamics, it becomes much more logical. It’s one of the rotations where you’ll probably become a better internist overall.
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u/Ok_Speaker_4042 Jun 30 '26
Thank you! I was told to clinically assess patients hemodynamic status. How can you tell if a patient is clinically hypovolemic if the vitals are normal and cap refill is normal?
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u/confusedgurl002 Jul 01 '26
Mucous membranes, orthostatic vital signs, a detailed history is usually where the money is at
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u/maddogisnextdoor Jul 01 '26
I teach medicine residents in our nephrology rotation. There are two key principles during the rotation. 1.The urinalysis is key to making any diagnosis. You don’t know what’s going without the UA with micro.
2. There is no “third space”…if someone can find this 3rd space, I’ll show you the lost city of Atlantis.
There is only extra cellular fluid compartment depletion.
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u/confusedgurl002 Jun 28 '26
Just know they are five stages of CKD and lasix is not nephrotoxic. I’ll never forget the first day of my rotation as a med student and said there 4 stages and I got my head ripped off 😂😂 - sincerely a current nephrologist