Renal (Kidney) - For Clinicians

How to make a referral

The Richard Bright Kidney Service welcomes referrals of patients with evidence of kidney disease. We use the National Chronic Kidney Disease guidance. We prefer use of the CKD referral pro-forma* that has been agreed with our commissioning CCGs accompanied by a brief letter with background information.

The pro-forma helps identify that the agreed criteria for referral have been met. If it is judged that a patient will not benefit from visiting the hospital outpatients then a letter of advice will be sent to the referrer.

All Consultants will accept referrals on any aspect of kidney disease and generic referrals to 'The Renal Unit Consultants' are preferred. Referrals to a particular Consultant may be diverted to a colleague if there would be an undue wait to be seen. If a referral clearly lies within a specialist interest of a particular consultant then the internal arrangements will ensure that the referral is directed appropriately.

Download Renal Assessment form PDF.

Drug dosing & eGFR calculators
The doses of many drugs need to be adjusted when GFR is reduced. Some drugs need to be avoided all together. The pharmacokinetic information about most drugs was derived before the use of eGFR based on MDRD equation was developed. Guidance for altering drug dosing when kidney function is impaired has most often been based on creatinine clearance which may have been derived from an equation such as Cockroft-Gault or timed urine collection. The major difference between Cockroft-Gault creatinine clearance and eGFR reported from the laboratory is caused by the normalisation of eGFR to a standard body surface area of 1.73m2.

We recommend that when considering drug dosing you should use a Cockroft-Gault calculation of creatinine clearance or MDRD eGFR corrected to the actual body surface area of the patient. Download GFR calculator (Excel) for these measurements.

The British National Formulary guidance on drugs and kidney function uses the following definition of kidney impairment.

Grade
Absolute GFR

Mild
20–50 mL/minute
Moderate
10–20 mL/minute
Severe
< 10 mL/minute

More information on eGFR can be found at http://www.renal.org.

Download Continuing good CKD management PDF.

Visit BNF at http://bnf.org/bnf/index.htm.

CKD guidelines
For National CKD guidelines as agreed between the Renal Association and the Royal College of General Practitioners, visit http://www.renal.org/

For February 2007 Consensus statement on management of early CKD, visit www.renal.org/CKDguide/consensus.html#Anchor-Bone-3800.

Download NBT Renal unit care pathways for CKD PDF.

Information for GPs about Home based dialysis treatments
Download Peritoneal dialysis PDF.
Download Haemodialysis PDF.

Vaccination against Hepatitis B for patients with Chronic Kidney Disease
Download vaccination schedule recommended by the Richard Bright Kidney unit and the Health Protection agency PDF.