Streatham & Clapham Health Renal 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) STAGE 4 CKD (eGFR 15-29) 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

Start JAN 2008 GRACEFIELD GARDENS 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