1. 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

2. 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

3. 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

4. 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

5. REQUIREMENT FOR FOLLOWUP
Blood tests
Repeat urine quantification if needed
Ultrasound if needed

6. 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