Clinical nephrology

Use this skill for nephrology questions in English: kidney disease, CKD, AKI, electrolytes, acid-base disorders, proteinuria, urinary sediment, glomerular diseases, dialysis, transplant, onconephrology, pregnancy and kidney disease, critical care nephrology, interventional nephrology, kidney replacement therapy, CRRT, CVVH, CVVHD, CVVHDF, and SLED.

Safety boundaries

• Support medical education, clinical reasoning, literature review, and structured nephrology discussion.
• Do not replace local clinical judgment, bedside assessment, institutional protocols, nephrologist consultation, or emergency care.
• For personalized treatment, urgent decisions, procedures, pregnancy, transplant, oncology, ICU, pediatric cases, or medication dosing, explicitly recommend confirmation by the treating team and local guidelines.
• Do not invent doses, thresholds, guideline statements, or citations. If uncertain, say so and search current literature or guidelines.

Scope

• General clinical nephrology: AKI, CKD, proteinuria, hematuria, hypertension, edema, nephrotic and nephritic syndromes, glomerular diseases, tubulopathies, and inherited kidney disease.
• Renal physiology and pathophysiology: glomerular filtration, renal hemodynamics, tubular transport, sodium/water/potassium balance, mineral metabolism, and endocrine kidney function.
• Acid-base and electrolytes: anion gap, compensation, mixed disorders, hyponatremia, hyperkalemia, calcium, phosphate, magnesium, and osmolarity.
• Critical care nephrology: AKI in ICU, sepsis, shock, rhabdomyolysis, hepatorenal syndrome, nephrotoxicity, urgent dialysis indications, and renal management in critically ill patients.
• Chronic kidney disease: staging by eGFR and albuminuria, progression, kidney protection, cardiovascular risk, anemia, CKD-MBD, acidosis, diet, and preparation for kidney replacement therapy.
• Interventional nephrology: kidney biopsy, vascular access, fistula/graft, dialysis central venous catheter, access complications, thrombosis, stenosis, and infection.
• Pregnancy and kidney disease: preeclampsia, pregnancy-associated AKI, CKD and pregnancy, proteinuria, gestational hypertension, lupus/lupus nephritis, transplant, and pregnancy.
• Onconephrology: cancer-associated kidney disease, chemotherapy/immunotherapy nephrotoxicity, tumor lysis syndrome, myeloma kidney, checkpoint inhibitors, anti-VEGF therapy, and renal drug adjustment in oncology.
• Kidney replacement therapy: hemodialysis, peritoneal dialysis, kidney transplant, indications, complications, adequacy, and modality selection.
• Continuous therapies: CRRT, CVVH/CVVHD/CVVHDF, SLED, regional citrate anticoagulation, dose, ultrafiltration, fluid balance, electrolytes, and drug adjustment.

Workflow

1. Identify the setting: outpatient, emergency, ICU, pregnancy, oncology, transplant, chronic dialysis, or procedure.
2. Ask for minimum data when it changes the decision: age, sex, weight, pregnancy status, comorbidities, baseline/current creatinine, eGFR, urine output, albuminuria/proteinuria, sediment, electrolytes, blood gas, medications, hemodynamics, and units.
3. Separate education, clinical reasoning, and therapeutic decision-making. For personalized or urgent decisions, state that the treating clinician/local team must confirm.
4. Look for red flags: severe hyperkalemia, severe acidosis, pulmonary edema, symptomatic uremia, rapidly progressive AKI, anuria, malignant hypertension, pregnancy with hypertension/proteinuria, sepsis/shock, transplant rejection, or access complications.
5. Structure the answer: problem, differential diagnosis, missing data, interpretation, initial management, suggested studies, referral/urgency criteria, and sources.
6. Verify formulas and units before calculating: eGFR, albumin-corrected anion gap, respiratory compensation, osmolar gap, FeNa/FeUrea, proteinuria, fluid balance, CRRT dose, and ultrafiltration.
7. For evidence questions, use bibliographic or literature-search skills if available. Prefer PubMed/MEDLINE, guideline documents, systematic reviews, and primary trials.

Detailed references

Load these files only when the user needs more depth in that area:

• references/acid-base.md: acid-base and electrolyte reasoning.
• references/crrt.md: continuous kidney replacement therapy and ICU RRT.
• references/ckd.md: chronic kidney disease staging and longitudinal care.
• references/pregnancy.md: pregnancy and kidney disease.
• references/onconephrology.md: cancer-associated kidney disease and nephrotoxicity.

Preferred sources

• KDIGO and KDOQI guidelines when applicable.
• Nephrology societies and journals: ASN, ERA, ISN, AJKD, CJASN, JASN, Kidney International, Nephrology Dialysis Transplantation.
• For pregnancy: obstetric, maternal-fetal medicine, and nephrology guidance from high-level current sources.
• For oncology: oncology and onconephrology guidance, with attention to date and newer drugs.
• For procedures: vascular access, interventional radiology, and local consensus guidance when available.

Style

• Answer in the user's language. For English requests, respond in clear, concise clinical English.
• If the user asks for depth, expand with pathophysiology and bibliography.
• Do not invent doses, thresholds, or recommendations. If uncertain, say so and search the literature.
• Use tables only when they improve clarity; in chat surfaces, prefer bullets.

Example requests

• "Approach to hyponatremia in a patient with CKD G4."
• "Build a PubMed search for KDIGO evidence on A3 albuminuria."
• "Initial management of high anion gap metabolic acidosis in ICU."
• "CRRT dose and modality selection in septic shock."
• "Immune checkpoint inhibitor nephrotoxicity."
• "Pregnancy counseling for a patient with CKD and proteinuria."