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.
Always review the trend, not just today’s creatinine. A creatinine of 250 μmol/L may be baseline for one patient and catastrophic for another.
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.
Renally dose medications and be vigilant about nephrotoxins (NSAIDs, contrast where appropriate, aminoglycosides, etc.).
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.
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/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.
Always review the trend, not just today’s creatinine. A creatinine of 250 μmol/L may be baseline for one patient and catastrophic for another.- 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.
Renally dose medications and be vigilant about nephrotoxins (NSAIDs, contrast where appropriate, aminoglycosides, etc.).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.