Streatham & Clapham HealthRenal Outreach Clinic

Dr Debasish Banerjee, Consultant Nephrologist, St. George’s Hospital

Dr Azhar Ala, General Practitioner,Wandsworth Road

Honorary Clinician, Dept. Renal Medicine, St. George’s Hospital

Who to refer

• STAGE 3 CKD (eGFR 30-59) – Progressive fall in GFR (>4ml/min per year) – Microscopic haematuria – Proteinuria, if prot/creat ratio >100mg/mmol – Unexplained anaemia (Hb <110g/l), abnormal potassium,

calcium or phosphate – Suspected systemic illness (e.g. SLE) – Uncontrolled BP (>150/90 on 3 agents)

• STAGE 4 CKD (eGFR 15-29)

Not achieving target BP control ie <130/80 or <125/75 for prot/creat ratio >100mg/mmol

HOW TO REFER

• Performa• Fax through to secretary AT ST.GEORGE’S• Contact back if need more information• Able to give clinic letter to patient at end of

appointment AND FAX TO GP

Valuable information for referral

• Brief history - particularly noting urinary symptoms, previous blood pressures, urine testing.

• Medications• Urine dipstick - and protein/creatinine ratio if +.• Blood tests - FBC, urea and electrolytes, calcium, albumin,

phosphate, cholesterol, HbA1c if diabetic.• Previous tests of renal function with dates, back to normal

renal function if possible• Imaging - results of renal imaging if undertaken

REQUIREMENT FOR FOLLOWUP

• Blood tests • Repeat urine quantification if needed• Ultrasound if needed

Evaluation

• Survey of patients and practices– Patient satisfaction- DOCTOR,INFORMATION

– Referring physician satisfaction– Rate of GFR decline– BP control- Initial visit and follow up

• Conversion of referrals to secondary care

Start JAN 2008 GRACEFIELD GARDENS 3 MONTH PILOT INITIALLY