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Consult: Nephrology for Complex AKI

Call the on-call nephrology fellow about a patient with acute kidney injury, preparing to be grilled on the lab data.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Dr. Singh in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

Consult Briefing

Your Objective

You are the hospitalist caring for a patient with an acute kidney injury (AKI) of unclear cause. Your goal is to call the on-call nephrology fellow, Dr. Singh. Nephrologists are famous for being data-driven. You MUST have all the relevant lab values ready, especially the urinalysis.

Patient: Michael Clark, 65M

  • Room: 815
  • Code Status: Full Code

Case Summary & Data

History: 65M with a history of diabetes and hypertension admitted for pneumonia. He was initially treated with IV fluids and antibiotics. Over the past 48 hours, his urine output has decreased, and his creatinine has been rising.

Workup So Far:

  • Creatinine Trend: Baseline was 1.2. On admission 1.4 -> Yesterday 1.9 -> Today 2.8.
  • Vitals: He is euvolemic (not dehydrated or fluid overloaded) on exam. BP is stable.
  • Medications: He has received IV vancomycin for his pneumonia. He has not received any IV contrast.
  • Imaging: A renal ultrasound was done and showed no signs of obstruction (hydronephrosis).
  • Urinalysis (UA): This is the key data. The UA shows 2+ blood, 1+ protein, and the urine microscopy report notes "muddy brown casts."

The Clinical Question

You have ruled out pre-renal (dehydration) and post-renal (obstruction) causes of AKI. The presence of muddy brown casts on the urinalysis is highly suggestive of Acute Tubular Necrosis (ATN), an intrinsic kidney disease, likely caused by his sepsis or the vancomycin.

Your "Ask": Your question for the nephrology fellow is: "I have a patient with an intrinsic AKI, likely ATN. I'd like your recommendations for management, specifically regarding his medications and fluid goals."

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Synthesize relevant patient data (history, vitals, labs, especially urinalysis) to present a clear case for a nephrology consult regarding complex AKI.
  • Structure the consultation call using the SBAR framework to efficiently communicate the situation, background, assessment, and recommendation.
  • Anticipate and prepare answers for key questions a nephrologist is likely to ask about a patient with acute kidney injury of unclear etiology.

In a patient with rising creatinine, which of the following urinalysis findings is most specific for Acute Tubular Necrosis (ATN)?

The presence of which of the following on urinalysis would most strongly suggest a glomerular cause of AKI, such as glomerulonephritis?

Which of the following is an absolute indication for emergent nephrology consultation and probable dialysis in a patient with AKI?