New eGFR 15 - 29
Review patient soon looking for any obvious reason for low eGFR.
- acute illness
- bladder outflow obstruction
- medication review - any new drugs eg diuretics, NSAIDs, ACEIs / ARBs
- heart failure / sepsis
Generally all patients with CKD stage 4 should be referred or discussed with renal medicine unless clinically inappropriate
- Repeat eGFR within a few days, if unwell then sooner
- Send urine for ACR and MSU and test for haematuria
- Request renal and bladder ultrasound examination
- Refer renal medicine
- If patient unwell and concerned about acute renal failure – consider telephone referral to on call renal consultant