UHCW Renal Unit
UHCW Renal Unit welcomes referral of patients with CKD, classified according to eGFR (ml/min/1.73m2).
Normal GFR is over 90mls/min/1.73m2. Normal serum creatinine (proportional to 1/eGFR) is 50-120 mcmol/L.
We are a regional centre of nephrology and transplantation, providing a service for the near 1 million people of Coventry and Warwickshire.
We provide a 24/7 service, with a Consultant of the Week model, who can be contacted through UHCW switchboard (02476 964 000).
There is more information re the renal team here: https://www.uhcw.nhs.uk/our-services-and-people/our-departments/renal-services/
Stage 5 (eGFR <15) Usually immediate referral or discussion.
We have a weekly HOT clinic for new patients with Stage 5, or can see such patients on the day on our Day Case Unit.
Please ring the Renal Registrar at UHCW on bleep 4134, or the consultant on call, both via UHCW switchboard (02476 964 000)
Stage 4 CKD (eGFR 15-29) Urgent referral or discussion; or routine referral if known to be stable
Stage 3 CKD (eGFR 30-59) Routine referral indicated if:
- Progressive fall in eGFR/rise in serum creatinine (eGFR >5ml/min/1.73m2 in one year) or 10ml/min /1.73m2 in 5 years
- Rapid change in either eGFR or creatinine (>25%). Consider AKI on CKD (and urgent AKI referral; see below)
- Stage 4 reached (GFR <30)
- Or, if associated with: Non-visible (microscopic) haematuria or Proteinuria, if ACR>70 or PCR >100mg/mmol
Stages 1-2 CKD (eGFR 60+) Referral not required unless other evidence of kidney disease (e.g. likely genetic diagnosis, urinary abnormalities, or evidence of structural renal disease on ultrasound)
‘3 actions in 3 months’ (including SGLT-2 inhibitors) in proteinuric CKD
SGLT2i are indicated in patients with proteinuric CKD.
UK Kidney Association (UKKA) guidelines (ref) suggest using a SGLT2i in patients with eGFR < 60 ml/min and > 25 ml/min, with a uACR > 25 mg/mmol.
Most of these patients will have Type 2 Diabetes. Some will have chronic glomerulonephritis and other causes of CKD.
But SGLT2is are now part of a package of therapy we would like offered to patients when proteinuric CKD is diagnosed – and carried out within 3 months please:
- Start ACE/ARB, and maximise dose – e.g Ramipril 10 mg OD, or Losartan 50 mg OD)
- Add SGLT2i – e.g. Dapagliflozin 10 mg OD or Canagliflozin 100 mg OD
- Get BP 130/80 or below, by adding other medication if necessary.
Then ask your practice nurse/pharmacist to monitor U+E/BP when stable, e.g, 3 monthly. If there are problems, please discuss with a renal consultant, via Choose and Book A&G, or refer.
Other Indications for Referral
- Acute Kidney Injury (Acute Renal Failure or AKI)
Immediate referral/discussion for most patients with AKI unless the cause and solution are obvious (eg patient in retention who needs a urinary catheter; if so, admit under general surgery)
Urgent referral: heavy proteinuria with low serum albumin (albumin < 30g/L, i.e. nephrotic syndrome)
Routine referral: urinary ACR >70 or PCR >100mg/mmol; or ACR >30 or PCR >50mg/mmol with non-visible (microscopic) haematuria in patients without diabetes >5 years
Do not refer: patients with diabetes (> 5 years) and normal renal function, and microalbuminuria / proteinuria (ie with presumed diabetic nephropathy)
Rapid referral – visible (macroscopic) haematuria should be referred to Urology (usually under the 2 Week Wait system).
If urological investigations are negative, refer (routinely) to Renal Medicine.
Routine referral – non-visible (microscopic) haematuria with proteinuria
Immediate referral – hypertensive emergency (accelerated hypertension). Refer to Ambulatory Emergency Clinic (or admit on medical take). GP Gateway has a separate page describing the Ambulatory Emergency Clinic.
Routine referral – uncontrolled (>150/90) blood pressure despite three agents at therapeutic doses, should be referred to the Hypertension Service at UCHW (Prof Cappuccio), unless the patient has CKD 4-5
- Systemic illness
Suspicion of renal involvement from a systemic illness (eg SLE) should lead to urgent referral or discussion
Information that it is valuable to send with referral:
- General medical history – particularly noting urinary symptoms, previous blood pressures, urine testing
- Medication history
- Urine dipstick result for haematuria and quantitation of proteinuria by ACR (preferably with PCR as well)
- Blood tests. Full blood count, urea and electrolytes. HbA1c if diabetic. If available, calcium, albumin, phosphate, cholesterol, PTH
- Previous tests of renal function with dates (especially if done in centres other than UHCW), back to normal renal function if possible
- Imaging – results of renal ultrasound if undertaken (pre-ordering may speed assessment)
We have specialist clinics in these areas: polycystic kidney disease, renal stone disease, cardiorenal syndrome, renal-diabetic (Rugby), vasculitis (with rheumatology) and renal-obstetric. You are welcome to refer your patient into these clinics.
UHCW Contact Information
We have a base Haemodialysis Unit at UHCW (tel. no. 02476 967777) and 5 satellite units at Rugby (tel. no. 01788 663236), George Eliot (tel. no. 02476 865692), Whitnash, Leamington (tel. no. 01926 470309), Stratford (tel. no. 01789 265520) and Clay Lane, Coventry (02476 964592). The Peritoneal Dialysis Unit (tel. no. 02476 968285). The Transplant Team (recipient tel. no. 02476 967744 / donor 02476 967750).
Renal Nurse Specialists
The Renal Nurse Specialists cover all aspects of pre-dialysis education, and are the patient’s primary point of contact – and responsible for liaison with primary care. Other responsibilities include: being the point of contact for EPO (erythropoietin), monitoring efficacy, dose adjustments and organising repeat prescriptions; and follow-up of conservative management patients including End-of-Life care. Contact the RNS Team (tel no. 02476 9677786).
If you have any nutritional concerns or diet related queries for a CKD patient please refer to the renal dietetic team at UHCW (tel. no. 02476 966151).
Renal Clinical Psychology Service
The Renal Unit offers Clinical Psychology support to any patient or relative (known to the team) affected by the emotional and psychological impact of living with kidney disease. Please ask for referral through their consultant.
Renal Ward W50 (tel 02476 96 8257 / 8259)
Transplant Ward W10 (tel 02476 96 5635 / 5633 / 5770)