COVID-19 and Renal referrals
In common with most other specialties, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.
The elderly, the immunocompromised, those with diabetes and smokers appear to be at greater risk of infection with COVID-19 and these demographics are highly pertinent to our renal patients.
We therefore plan to restrict outpatients to urgent referrals.
In all patients who will be referred to our services urgently please arrange relevant tests- the advice provided below. The non-urgent queries could be sent via Advice and Guidance portal.
1. CKD 4- eGFR 15-29: if progressive decline- eGFR dropped by 10 ml/min in last 12 months
2. Heavy proteinuria with low serum albumin (nephrotic syndrome) or if associated with rapidly progressive renal impairment
3. Systemic illness- suspicion of renal involvement from a systemic illness (e.g . myeloma, vasculitis, sarcoidosis)
4. Acute kidney injury/ malignant hypertension – discussion with renal team via switchboard- patient might require admission to hospital
1) CKD: – eGFR 15-29: If eGFR stable and clear cause of CKD ( e.g. longstanding diabetes, hypertension) defer referring for time being unless CKD complications such as anaemia (Hb <100 g/l).
– eGFR 30-59: if progressive renal impairment as defined by sustained decrease in GFR of ≥15 ml/min/1.73m2 within 12 months
– 60+ : referral not required unless other evidence of kidney disease (e.g. Likely genetic diagnosis- ADPKD, Gitleman syndrome, associated urinary abnormalities
2) Proteinuria- urinary ACR>70 or PCR>100mg/mmol-new finding without clear cause (diabetes, hypertension)
3) Haematuria – visible haematuria with negative urological investigations or with strong features of renal disease and microscopic haematuria with proteinuria as above
4) Hypertension- uncontrolled (>150/90) BP despite 4 agents at therapeutic doses and suspicion of secondary cause of hypertension. Please contact renal team via Advice and Guidance if advice needed urgently, otherwise refer to Hypertension NICE guidelines.
Tests to be arranged before urgent appointment:
1. CKD- FBC, UE’s, bicarbonate, liver function, bone profile, PTH, iron stores, urinary ACR if urine dip positive for protein
2. Systemic illness, nephrotic syndrome, some cases of AKI (in those where cause not obvious) – complement, ANA, ANCA, myeloma screen, bone profile