Nephrology — New Patient Consultation Template

Consultation Information

Referring physician: [Name, specialty]
Reason for referral: [Chief complaint]
Date of consultation: [Date]
Urgency: Routine / Urgent

Chief Complaint

[Primary nephrology concern]
Duration: [X] days/weeks/months/years
Current status: Stable / Progressive / Acute deterioration

History of Present Illness

For Chronic Kidney Disease

CKD History:

Duration of known CKD: [X] months/years
Presumed etiology: [Diabetes / HTN / GN / PKD / Unknown / Other]
Baseline creatinine: [X] mg/dL — Date: [X]
Current creatinine: [X] mg/dL
Rate of decline: [X] mL/min/year
Prior nephrology care: None / [Provider, date]

CKD Stage Progression:

Date	Creatinine	eGFR	Stage
[X]	[X]	[X]	[X]
[X]	[X]	[X]	[X]
[X]	[X]	[X]	[X]

Proteinuria History:

UACR: [X] mg/g — Date: [X]
24-hour urine protein: [X] mg/day — Date: [X]
Trend: Stable / Improving / Worsening

For Acute Kidney Injury

AKI Presentation:

Baseline creatinine: [X] mg/dL
Peak creatinine: [X] mg/dL
KDIGO Stage: [1/2/3]

• Stage 1: Cr increase ≥0.3 or 1.5-1.9x baseline
• Stage 2: Cr 2.0-2.9x baseline
• Stage 3: Cr ≥3.0x baseline or ≥4.0 or initiation of RRT

Urine output: [X] mL/day — Oliguria: Yes / No
Timeline: [Course of AKI]

Potential Etiologies:

Pre-renal:

• Hypovolemia: [Bleeding, GI losses, poor intake]
• Hypotension: [Sepsis, cardiac, medications]
• Medications: [NSAIDs, ACEi/ARB, diuretics]

Intrinsic:

• ATN: [Ischemic, nephrotoxic]
• Interstitial nephritis: [Drug-induced, infection]
• Glomerulonephritis: [Suspected type]
• Vascular: [Atheroembolic, TMA]

Post-renal:

• Obstruction: [BPH, stones, malignancy]

For Glomerulonephritis

Presentation:

Nephrotic: Proteinuria >3.5g/day, edema, hypoalbuminemia, hyperlipidemia
Nephritic: Hematuria, RBC casts, HTN, modest proteinuria, AKI
Mixed features: Yes / No

Suspected Etiology:

Primary glomerular: [MCD, FSGS, MN, IgAN, MPGN]
Secondary: [Diabetes, lupus, amyloid, infection-related]
Prior kidney biopsy: None / [Date, findings]

For Electrolyte Abnormalities

Hyponatremia:

Sodium: [X] mEq/L — Duration: [Acute/chronic]
Symptoms: None / [Confusion, seizure, nausea]
Volume status: Hypovolemic / Euvolemic / Hypervolemic
Serum osmolality: [X] mOsm/kg
Urine osmolality: [X] mOsm/kg
Urine sodium: [X] mEq/L

Hyperkalemia:

Potassium: [X] mEq/L
ECG changes: None / [Peaked T, widened QRS, etc.]
Medications: [ACEi, ARB, K-sparing diuretics, NSAIDs]
Diet: [Potassium intake]

Metabolite Acidosis:

pH: [X], Bicarbonate: [X] mEq/L
Anion gap: [X] — Elevated / Normal
Etiology: [CKD, RTA, lactic, ketoacidosis, toxic]

CKD Complications

Anemia:

Hemoglobin: [X] g/dL
Iron studies: Ferritin [X], TSAT [X]%
ESA therapy: None / [Drug, dose]

Mineral Bone Disease:

Calcium: [X] mg/dL
Phosphorus: [X] mg/dL
PTH: [X] pg/mL
Vitamin D 25-OH: [X] ng/mL
Vitamin D 1,25-OH: [X] pg/mL

Volume/BP:

Edema: None / [1-4+, location]
Weight change: [+/- X] lbs
Blood pressure: [Current control]

Uremic Symptoms:

Fatigue: None / Mild / Moderate / Severe
Anorexia: None / Present
Nausea: None / Present
Pruritus: None / Present
Sleep disturbance: None / Present
Cognitive changes: None / Present

Dialysis/Transplant History (if applicable)

Dialysis: Never / Current / Prior

• Modality: HD / PD
• Access: [Fistula, graft, catheter — location]
• Start date: [X]
• Schedule: [X times/week, X hours]
• Adequacy: Kt/V [X]

Transplant: Never / [Date, type, donor]

• Prior rejections: None / [Episodes]
• Current immunosuppression: [Regimen]

Past Medical History

Diabetes: No / Yes — Duration: [X] years, A1c: [X]%

• Complications: Retinopathy / Neuropathy / Nephropathy

Hypertension: No / Yes — Duration: [X] years

• Control: Good / Fair / Poor

Heart failure: No / Yes — EF: [X]%
CAD: No / Yes — [Interventions]
PVD: No / Yes
Lupus/autoimmune: No / Yes — [Type]
Hepatitis B/C: No / Yes — [Status]
HIV: No / Yes — [Status]
PKD: No / Yes — [Family history]
Malignancy: No / Yes — [Type, treatment]

Surgical History

[Relevant surgeries, especially:]
Kidney biopsy: None / [Date, findings]
Dialysis access procedures: None / [Type, date, location]
Transplant: None / [Date, type]
Nephrectomy: None / [Reason]
Urologic surgery: None / [Procedure]

Medications

Current medications: [List with doses]
Nephrotoxic medications:

• NSAIDs: No / Yes — [Drug, frequency]
• Aminoglycosides: No / Yes
• Contrast: Recent / [Date]
• Lithium: No / Yes
• Other: [List]

Renally-dosed medications: [Confirm appropriate dosing]

Allergies

[Drug allergies with reactions]
Contrast allergy: No / Yes — [Reaction, premedication]

Family History

CKD/ESRD: No / Yes — [Relationship, etiology]
PKD: No / Yes — [Relationship]
Diabetes: No / Yes — [Relationship]
Hypertension: No / Yes — [Relationship]

Social History

Tobacco: Current / Former / Never — Pack-years: [X]
Alcohol: [Quantity, frequency]
Employment: [Status, disability]
Insurance: [Type — relevant for transplant/dialysis]
Living situation: [Support system]
Transportation: [Access to dialysis if needed]

Physical Examination

Vital Signs

BP: [X/X] — [Seated, standing]
HR: [X]
Temp: [X]°F
Weight: [X] — Dry weight (if dialysis): [X]
I&O: [If applicable]

General

Appearance: Well / [Uremic, volume overloaded, ill]
Distress: None / [Description]

HEENT

Sclera: Anicteric / Icteric
Conjunctiva: Pink / Pale
JVD: Absent / [X] cm above sternal angle

Cardiovascular

Rhythm: Regular / [Irregular]
Murmurs: None / [Description]
Rub: Absent / Present
Edema: None / [Grade, distribution]

Pulmonary

Breath sounds: Clear / [Crackles — location]
Pleural effusion: Absent / [Side]

Abdominal

Soft / [Distended]
Ascites: Absent / Present — [Shifting dullness, fluid wave]
Kidneys: Not palpable / Enlarged [PKD]
Bruit: Absent / Present
Transplant kidney: [If present — tender, size]

Extremities

Edema: None / [Grade 1-4, pitting, distribution]
Pulses: [Intact / Diminished]

Dialysis Access (if applicable)

Type: Fistula / Graft / Catheter
Location: [Anatomic site]
Thrill: Present / Absent
Bruit: Present / Absent
Signs of infection: None / [Erythema, drainage, tenderness]
Steal syndrome: Absent / [Present — symptoms]

Skin

Uremic frost: Absent / Present
Excoriations: None / [From pruritus]
Calciphylaxis: Absent / [Lesions]

Neurologic

Asterixis: Absent / Present
Mental status: Alert / [Encephalopathy]
Peripheral neuropathy: Absent / Present

Laboratory Review

Renal Function

Date	Creatinine	BUN	eGFR	Stage
[Current]	[X]	[X]	[X]	[X]
[Prior]	[X]	[X]	[X]	[X]

Electrolytes

Sodium: [X] mEq/L
Potassium: [X] mEq/L
Chloride: [X] mEq/L
Bicarbonate: [X] mEq/L
Anion gap: [X]
Calcium: [X] mg/dL (corrected: [X])
Phosphorus: [X] mg/dL
Magnesium: [X] mg/dL

CBC

Hemoglobin: [X] g/dL
Hematocrit: [X]%
Platelets: [X]

Iron Studies

Ferritin: [X] ng/mL
TSAT: [X]%
Iron: [X]
TIBC: [X]

Mineral Bone

PTH: [X] pg/mL
Vitamin D 25-OH: [X] ng/mL
Alkaline phosphatase: [X]

Urinalysis

Specific gravity: [X]
pH: [X]
Protein: [X]
Blood: [X]
RBC: [X]/hpf
WBC: [X]/hpf
Casts: None / [Type]
Crystals: None / [Type]

Proteinuria Quantification

UACR: [X] mg/g — Category: [A1/A2/A3]
UPCR: [X] mg/g
24-hour urine protein: [X] mg/day

Serologies (if indicated)

ANA: [Result]
Anti-dsDNA: [Result]
Complement C3/C4: [Results]
ANCA: [Result]
Anti-GBM: [Result]
Hepatitis B/C: [Status]
HIV: [Status]
SPEP/UPEP: [Results]
Kappa/Lambda: [Results]

Imaging

Renal ultrasound: [Date]

• Right kidney: [X] cm, [Echogenicity, cysts, hydronephrosis]
• Left kidney: [X] cm, [Findings]
• Bladder: [PVR]

Other imaging: [CT, MRI, nuclear scan — findings]

Assessment

CKD Staging (if CKD)

eGFR: [X] mL/min/1.73m² — Stage: [G1-G5]
Albuminuria: [X] mg/g — Category: [A1-A3]
KDIGO Risk: [Low / Moderate / High / Very High]
1) [Primary nephrology diagnosis]

• Etiology: [Known/presumed]
• Stage/severity: [X]
• Trajectory: [Stable/progressive, rate]

2) [Secondary diagnoses — CKD complications, electrolyte issues]
3) [Comorbidities affecting kidney disease]

Plan

Diagnostic Workup

• [ ] Repeat labs: [BMP, CBC, etc.]
• [ ] 24-hour urine: [Protein, creatinine clearance, electrolytes]
• [ ] Serologic workup: [ANA, ANCA, complement, etc.]
• [ ] Renal ultrasound
• [ ] Kidney biopsy — Indication: [X]
• [ ] Other: [Specify]

Medical Management

Blood Pressure:

• Target: <130/80 (or <120/80 if tolerated)
• [ ] ACEi/ARB: [Drug, dose] — Maximize if tolerated
• [ ] Other antihypertensives: [As needed]
• [ ] Diuretic: [Drug, dose]
• [ ] SGLT2 inhibitor: [Drug, dose] — For CKD progression

Proteinuria:

• [ ] Maximize ACEi/ARB
• [ ] SGLT2 inhibitor
• [ ] MRA (finerenone): [If indicated]
• [ ] Dietary protein restriction

Diabetes (if applicable):

• A1c target: [X]%
• [ ] SGLT2 inhibitor (dual benefit)
• [ ] GLP-1 agonist
• [ ] Renally dose other agents

CKD-MBD:

• [ ] Phosphate binder: [Drug, dose]
• [ ] Vitamin D: [Ergocalciferol / Calcitriol / Paricalcitol]
• [ ] Calcimimetic: [If indicated]

Anemia:

• Target Hgb: 10-11 g/dL
• [ ] Iron supplementation: [Oral / IV]
• [ ] ESA: [Drug, dose, frequency]

Metabolic Acidosis:

• Target bicarbonate: >22 mEq/L
• [ ] Sodium bicarbonate: [Dose]

Hyperkalemia:

• [ ] Dietary counseling
• [ ] Potassium binder: [Drug, dose]
• [ ] Adjust medications

Volume:

• [ ] Sodium restriction
• [ ] Fluid restriction: [X] L/day
• [ ] Diuretics: [Drug, dose]

Renal Replacement Planning (if approaching ESRD)

Estimated time to ESRD: [X] months
Modality education: [ ] Provided / [ ] Scheduled

• [ ] Hemodialysis
• [ ] Peritoneal dialysis
• [ ] Home hemodialysis
• [ ] Conservative/palliative care

Vascular access:

• [ ] Refer for fistula creation
• [ ] Avoid venipuncture/IVs in non-dominant arm

Transplant:

• [ ] Transplant referral
• [ ] Living donor education

Medication Adjustments

• [ ] Renally dose: [Medications]
• [ ] Discontinue nephrotoxic: [Medications]
• [ ] Avoid contrast if possible

Referrals

• [ ] Vascular surgery (access)
• [ ] Transplant nephrology
• [ ] Dietitian
• [ ] Social work
• [ ] Diabetes educator
• [ ] Other: [Specify]

Patient Education

• CKD stage and prognosis explained
• Dietary restrictions reviewed (sodium, potassium, phosphorus, protein)
• Medication instructions
• Avoid NSAIDs, nephrotoxins
• Importance of BP and glucose control
• Signs of volume overload
• When to call (symptoms of uremia, hyperkalemia)

Follow-up

Return: [X] weeks/months

• Labs prior to visit: [Specific tests]
• More frequent if: [CKD stage 4-5, rapid progression]

Sooner if: [Oliguria, severe edema, dyspnea, confusion, hyperkalemia symptoms]

Communication

Discussed with patient/family: [Topics, goals of care]
Report sent to: [Referring physician, PCP]