# CKD-Focused OSCE History Checklist

**Station:** Chronic Kidney Disease Assessment | **Time:** 5-10 minutes | **Format:** History-taking focused on CKD identification and staging

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## A. OPENING & RAPPORT
- [ ] Greet patient, introduce self, verify name/DOB
- [ ] Explain purpose of consultation
- [ ] Confirm consent and obtain permission to take notes
- [ ] Position comfortably, make eye contact, use open body language

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## B. PRESENTING COMPLAINT & DURATION
- [ ] Open-ended question: "What brings you in today?" / "Tell me about your concerns"
- [ ] Duration of symptoms
- [ ] Clarify if patient is aware of kidney disease
- [ ] Ascertain whether routine check-up, referral, or acute problem

**Red flags to identify:**
- [ ] Fatigue, lethargy, malaise
- [ ] Nausea, vomiting, anorexia
- [ ] Swelling (face, hands, feet, abdomen)
- [ ] Shortness of breath
- [ ] Joint/bone pain
- [ ] Itching/skin changes

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## C. RISK FACTORS FOR CKD (ESSENTIAL)

### C1. DIABETES
- [ ] Type 1 or Type 2 diabetes?
- [ ] How long? (Age at diagnosis, number of years)
- [ ] Current control: A1C, last check? (if known)
- [ ] On insulin, oral agents, lifestyle modification?
- [ ] Known diabetic complications? (retinopathy, neuropathy, nephropathy)
- [ ] Blood sugar monitoring at home?

### C2. HYPERTENSION
- [ ] Known hypertension? When diagnosed?
- [ ] Current BP readings (at home or clinic)?
- [ ] Medications: ACE inhibitor, ARB, calcium channel blocker, diuretic, beta-blocker, other?
- [ ] Adherence to medications?
- [ ] Previous BP control?
- [ ] Any episodes of very high BP or hypertensive crisis?

### C3. FAMILY HISTORY
- [ ] Family history of kidney disease?
- [ ] Family history of diabetes, hypertension?
- [ ] Family history of polycystic kidney disease or genetic renal disease?
- [ ] Family history of ESRD requiring dialysis or transplant?

### C4. OTHER CKD RISK FACTORS
- [ ] Autoimmune disease? (SLE, vasculitis, IgA nephropathy)
- [ ] Glomerulonephritis or recurrent urinary infections?
- [ ] Kidney stones or obstruction?
- [ ] Recurrent UTIs or pyelonephritis?
- [ ] Enlarged prostate (BPH) or urinary retention?
- [ ] History of contrast exposure or nephrotoxic drugs?
- [ ] Chronic NSAID use? Herbal or traditional medicine use?

### C5. SOCIAL & OCCUPATIONAL
- [ ] Smoking history (pack-years)?
- [ ] Alcohol consumption?
- [ ] Illicit drug use?
- [ ] Occupational exposures (heavy metals, silica)?

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## D. SYSTEMS REVIEW FOR CKD COMPLICATIONS

### D1. CARDIOVASCULAR
- [ ] Chest pain, angina, or shortness of breath?
- [ ] Palpitations or heart problems diagnosed?
- [ ] History of MI, stroke, or TIA?
- [ ] Known hypertension (already covered in C2)?
- [ ] Leg swelling or pain (DVT/PAD)?

### D2. FLUID OVERLOAD SYMPTOMS
- [ ] Swelling of legs, feet, face, or abdomen?
- [ ] Recent weight gain (rapid)?
- [ ] Shortness of breath, especially lying down (orthopnea)?
- [ ] Waking at night short of breath (PND)?
- [ ] Difficulty breathing with exertion?

### D3. URINARY SYMPTOMS
- [ ] Change in urine output (decreased, frequent)?
- [ ] Nocturia? How many times per night?
- [ ] Visible blood in urine (hematuria)?
- [ ] Frothy or foamy urine (proteinuria)?
- [ ] Dysuria, frequency, urgency, hesitancy?
- [ ] Incontinence?

### D4. CONSTITUTIONAL SYMPTOMS
- [ ] Fatigue: when started? Worse with activity?
- [ ] Weakness, lethargy?
- [ ] Low appetite, nausea, vomiting?
- [ ] Metallic taste in mouth?
- [ ] Weight loss or weight gain?
- [ ] Fever, chills, night sweats?

### D5. BONE & MINERAL DISORDERS (CKD-MBD)
- [ ] Bone pain or aches?
- [ ] Muscle cramps or spasms?
- [ ] Fractures or falls?
- [ ] Itching/skin changes (uremic pruritus)?

### D6. NEUROLOGICAL
- [ ] Headaches?
- [ ] Confusion, memory problems, cognitive changes?
- [ ] Difficulty concentrating?
- [ ] Peripheral tingling/numbness (neuropathy)?
- [ ] Seizures?

### D7. GASTROINTESTINAL
- [ ] Nausea, vomiting?
- [ ] Loss of appetite?
- [ ] Constipation or diarrhea?
- [ ] Abdominal pain or discomfort?
- [ ] Oral ulcers or taste changes?

### D8. ANEMIA-RELATED
- [ ] Pallor, shortness of breath?
- [ ] Fatigue (worse than expected)?
- [ ] Dizziness or lightheadedness?
- [ ] Chest pain with exertion?

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## E. PAST RENAL HISTORY

- [ ] Any previous kidney tests? (baseline creatinine, eGFR, urinalysis)
- [ ] When was kidney disease first identified?
- [ ] Any previous renal imaging (ultrasound, CT)?
- [ ] Any renal biopsies performed?
- [ ] Previous hospitalizations for kidney issues?
- [ ] Ever told diagnosis of specific kidney disease? (IgA, FSGS, MPGN, membranous, etc.)

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## F. PAST MEDICAL HISTORY (Expanded for CKD Context)

- [ ] Acute kidney injury (AKI) previously?
- [ ] Acute glomerulonephritis?
- [ ] Pyelonephritis or recurrent UTI?
- [ ] Urolithiasis (kidney stones)?
- [ ] BPH, prostate disease?
- [ ] Autoimmune diseases (SLE, vasculitis, Sjögren's)?
- [ ] Hepatitis B or C?
- [ ] HIV?
- [ ] Malignancy (especially myeloma, lymphoma)?
- [ ] Hypertension, diabetes (already covered)
- [ ] Cardiovascular disease (MI, stroke, PAD)
- [ ] Heart failure?
- [ ] Connective tissue disease?
- [ ] Recurrent infections?

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## G. MEDICATIONS (CRITICAL FOR CKD)

**Ask about ALL medications, including:**
- [ ] ACE inhibitors or ARBs (for BP/proteinuria)?
- [ ] Diuretics?
- [ ] Beta-blockers, calcium channel blockers?
- [ ] NSAIDs? (Frequency and duration)
- [ ] Statins?
- [ ] Anticoagulants (warfarin, DOACs)?
- [ ] Diabetic medications (metformin, GLP-1, SGLT2i)?
- [ ] Phosphate binders?
- [ ] Vitamin D or calcimimetics?
- [ ] Erythropoiesis-stimulating agents (ESA)?
- [ ] Antibiotics (aminoglycosides, fluoroquinolones)?
- [ ] Herbal supplements or traditional remedies?
- [ ] Over-the-counter analgesics?

**For each medication:**
- [ ] Name, dose, frequency
- [ ] How long taking?
- [ ] Adherence/compliance?
- [ ] Any side effects?
- [ ] Recent dose changes?

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## H. ALLERGIES & ADVERSE REACTIONS
- [ ] Drug allergies?
- [ ] Reactions to contrast agents (important for CKD)?
- [ ] ACE inhibitor cough or angioedema?
- [ ] Other medication intolerances?

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## I. SOCIAL HISTORY (CKD Context)

### I1. LIVING SITUATION
- [ ] Lives alone or with family?
- [ ] Has caregiving support?
- [ ] Adequate housing, utilities?
- [ ] Access to kitchen for dietary management?

### I2. EMPLOYMENT & FUNCTIONAL STATUS
- [ ] Currently working? Full-time/part-time?
- [ ] Able to perform activities of daily living (ADLs)?
- [ ] Functional limitations from CKD symptoms?
- [ ] Need for work/school adjustments?

### I3. LIFESTYLE
- [ ] Regular exercise? (if tolerated by CKD stage)
- [ ] Dietary habits: high salt, high protein, processed foods?
- [ ] Fluid intake awareness?
- [ ] Able to follow dietary/fluid restrictions?

### I4. SOCIAL SUPPORT
- [ ] Family understanding of CKD?
- [ ] Emotional support available?
- [ ] Previous nephrology care or education?

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## J. DIALYSIS & RENAL REPLACEMENT THERAPY (If applicable)

- [ ] Ever been on dialysis or need for dialysis discussed?
- [ ] Vascular access? (Fistula, graft, catheter)
- [ ] On dialysis now? Type, frequency, duration?
- [ ] Transplant history or on waiting list?
- [ ] Complications of dialysis or transplant?

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## K. PREVIOUS INVESTIGATIONS & MONITORING

- [ ] Last serum creatinine? eGFR? When?
- [ ] Last urinalysis? (proteinuria, hematuria?)
- [ ] 24-hour urine protein or spot urine protein/creatinine ratio?
- [ ] Last electrolytes (K+, Na+, HCO3-)?
- [ ] Last hemoglobin? (checking for anemia)
- [ ] Last calcium, phosphate, PTH?
- [ ] Lipid profile?
- [ ] Imaging: renal ultrasound, CT, MRI? Findings?
- [ ] Renal biopsy? Pathology results?
- [ ] Regular monitoring by nephrologist? How often?

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## L. PREVIOUS INTERVENTIONS & MANAGEMENT

- [ ] Previous counseling on salt, fluid, protein restriction?
- [ ] Previous BP goal and management?
- [ ] Previous patient education on CKD?
- [ ] Any specialist referrals (cardiology, nephrology, endocrinology)?
- [ ] Any previous attempts at treatment modification?

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## M. PROGRESSION & STABILITY

- [ ] Trend in kidney function? (Stable, declining, rapidly declining?)
- [ ] If declining: how fast? (GFR slope?)
- [ ] Any recent acute worsening?
- [ ] Recent infections, exposures, or medication changes that might affect kidneys?
- [ ] Changes in proteinuria or hematuria?

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## N. PATIENT UNDERSTANDING & GOALS

- [ ] Does patient understand they have kidney disease?
- [ ] What does the patient know about their diagnosis?
- [ ] Patient's understanding of disease progression and prognosis?
- [ ] Patient's goals of care?
- [ ] Concerns or anxieties about kidney disease?
- [ ] Readiness for dialysis, transplant, or conservative management?

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## O. COMPLIANCE & BARRIERS

- [ ] Medication adherence challenges?
- [ ] Dietary adherence (salt, fluid, protein restrictions)?
- [ ] Financial barriers to medications or appointments?
- [ ] Difficulty accessing specialist care?
- [ ] Language or health literacy barriers?

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## SUMMARY OF KEY EXAM FINDINGS TO COMMUNICATE

After history taking, note:

**CKD Stage Indicators (from history):**
- [ ] GFR range (if known): _____ mL/min/1.73m²
- [ ] Presence of proteinuria/hematuria: _____
- [ ] Duration of kidney disease: _____

**Red Flags Identified:**
- [ ] AKI risk or recent acute change
- [ ] Advanced CKD (stages 4-5)
- [ ] Uncontrolled HTN or DM
- [ ] Signs of uremia or complications
- [ ] Medication-related issues

**Patient Readiness for Management:**
- [ ] Level of health literacy
- [ ] Adherence potential
- [ ] Need for education or referral

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## DOCUMENTATION CHECKLIST

Before leaving the station, ensure you have elicited and documented:

- [ ] Clear risk factor profile (DM, HTN, family history)
- [ ] CKD-related symptoms (if any)
- [ ] Degree of functional impairment
- [ ] Current management and medications
- [ ] Awareness and understanding of diagnosis
- [ ] Barriers to care and compliance
- [ ] Impression of CKD stage and urgency of intervention
- [ ] Plan for investigations or referral (if applicable)

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## DIFFERENTIAL CONSIDERATIONS

While taking history, consider other causes of abnormal renal function:

- **Acute kidney injury (AKI)** - recent change, reversible
- **Prerenal azotemia** - dehydration, hypotension
- **Intrinsic renal disease** - glomerulonephritis, interstitial nephritis
- **Postrenal obstruction** - BPH, stones, malignancy
- **Diabetic nephropathy** - DM + proteinuria + HTN
- **Hypertensive nephrosclerosis** - severe/uncontrolled HTN
- **Secondary CKD** - SLE, vasculitis, amyloidosis, HIV, hepatitis C

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## OSCE MARK SCHEME (Examiner Reference)

**Communication & Rapport** (5-10%)
- [ ] Respectful, empathetic approach
- [ ] Clear explanations
- [ ] Appropriate use of open and closed questions

**Risk Factor Elicitation** (20-25%)
- [ ] Systematically covered diabetes, hypertension, family history
- [ ] Explored other risk factors
- [ ] Identified relevant past medical history

**Symptom Assessment** (20-25%)
- [ ] Thorough systems review for CKD complications
- [ ] Identified constitutional, urinary, and cardiovascular symptoms
- [ ] Probed functional impact

**Drug & Allergy History** (10-15%)
- [ ] Complete medication list
- [ ] Key CKD-relevant drugs identified (ACE-I, ARB, NSAIDs)
- [ ] Allergy to contrast noted

**Investigations & Monitoring** (10-15%)
- [ ] Asked about previous renal tests
- [ ] Enquired about renal imaging
- [ ] Assessed frequency of monitoring

**Patient Understanding & Compliance** (5-10%)
- [ ] Assessed patient knowledge
- [ ] Identified adherence barriers
- [ ] Gauged readiness for management

**Organization & Efficiency** (5-10%)
- [ ] Logical flow of questions
- [ ] Appropriate time management
- [ ] Clear summary at end

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**Total Duration:** 5-10 minutes | **Aim:** Obtain comprehensive history relevant to CKD staging, complications, and management planning