It's Friday, 3 p.m., and the phone rings ... a practical approach to common nephrology consultations-Part 1.

This practical approach highlights the importance of timely recognition and management of various nephrological emergencies. The featured conditions pose an extraordinary challenge, since their recognition, timely workup and immediate bedside management are often only roughly pictured in guidelines. This article provides case-based insights and highlights pitfalls with regards to current guidelines on the management of acute conditions frequently managed by nephrologists. The first case, acute allograft dysfunction, underscores the critical need to distinguish between various etiologies of acute kidney injury (AKI) to guide targeted interventions effectively. Case 2 explores the challenges of managing acute infections in kidney transplant recipients, highlighting the necessity of tailoring immunosuppressive therapy, conducting a thorough diagnostic workup, and ensuring timely and adequate treatment. Case 3 focuses on the recognition and management of pulmonary-renal syndrome, emphasizing the importance of initiating serological testing, planning for biopsy, and administering empirical immunosuppressive therapy. In Case 4, a structured and pragmatic approach to diagnosis and treatment of thrombotic microangiopathy, with an emphasis on identifying potential pitfalls to prevent delays in therapy is given. Case 5 focuses AKI in pregnancy, a high-stakes condition that requires prompt and comprehensive diagnostic evaluation to minimize risks to both mother and child. Finally, Case 6 presents a diagnostic and treatment framework for managing suspected infections of a tunneled hemodialysis catheter, aiming to optimize outcomes through early and effective interventions.