Chronic Kidney Disease and End-Stage Renal Disease — WACS Viva & Clinical Scenarios (Nephrology)

Exam-style chronic kidney disease and end-stage renal disease viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 46-year-old male commercial driver presents to the medical outpatient clinic with a 6-month history of worsening bilateral lower limb swelling, early morning facial puffiness, easy fatigability, nocturia, and poorly controlled hypertension. Baseline laboratory investigations reveal serum creatinine of 420 micromol/L, estimated GFR of 14 mL/min/1.73 m2, spot urine albumin-to-creatinine ratio of 850 mg/g, and contracted echogenic kidneys on renal ultrasonography. Formulate the comprehensive diagnostic formulation, KDIGO staging, aetiological evaluation with reference to regional drivers in Wes
• SCENARIO 2: A 52-year-old woman with stage 4 CKD secondary to long-standing type 2 diabetes mellitus has the following biochemical profile: serum calcium 2.05 mmol/L, serum phosphate 2.10 mmol/L, intact parathyroid hormone (iPTH) 480 pg/mL (normal range 15 to 65 pg/mL), 25-hydroxyvitamin D 18 ng/mL, and alkaline phosphatase 190 IU/L. Explain the pathophysiological sequence underlying these abnormalities, classify the CKD-Mineral and Bone Disorder (CKD-MBD), and outline your stepwise pharmacological intervention.
• SCENARIO 3: Discuss the pharmacological and non-pharmacological strategies proven to retard the progression of non-diabetic and diabetic chronic kidney disease. Detail the practical initiation, safety boundaries, and monitoring rules for renin-angiotensin-aldosterone system (RAAS) inhibitors and sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with reduced GFR.
• SCENARIO 4: A 38-year-old male with stage 5 CKD (non-dialysis dependent) presents with severe symptomatic anaemia with a haemoglobin concentration of 6.8 g/dL. Explain your systematic laboratory evaluation to differentiate anaemia of CKD from concurrent nutritional or haemolytic causes, state the target indices for iron repletion, and structure a protocol for safe erythropoiesis-stimulating agent (ESA) initiation and monitoring.
• SCENARIO 5: A 58-year-old hypertensive patient has a progressive decline of estimated GFR to 11 mL/min/1.73 m2 over 12 months. Describe the comprehensive multidisciplinary preparation required for transition to end-stage renal disease care, including timely vascular access mapping and creation, cardiovascular risk mitigation, pre-transplant assessment, and the structured framework for conservative, non-dialytic supportive management in a resource-limited West African context.