When to see a nephrologist

This page describes the reasons that international guidelines, mainly KDIGO 2024 and the UK's NICE guideline, give for specialist referral. It is not a set of rules for deciding on your own. Your doctor looks at your full picture, including your age, other conditions and how your results have changed over time.

How doctors look at kidney results

Two tests matter most. The first is eGFR, the estimated glomerular filtration rate. It is calculated from your blood creatinine level using a validated equation and shows roughly how well your kidneys filter. The second is urine ACR, the albumin-to-creatinine ratio, which shows how much albumin (a protein) is leaking into your urine.

A single creatinine result does not diagnose kidney disease. Chronic kidney disease (CKD) means that eGFR is reduced, or there are signs of kidney damage such as raised ACR, for more than 3 months. Doctors use eGFR and ACR together, and over time, to decide how closely to monitor you and whether specialist input would help.

Common reasons doctors refer

Guidelines differ a little on exact cut-offs, so your doctor will apply the one they use. In general terms, doctors commonly refer when:

• eGFR stays below 30. This is CKD stage G4 or G5 (eGFR 15 to 29, or below 15). At this level, specialist planning becomes more important.
• ACR is significantly raised and stays that way. KDIGO uses an ACR of 30 mg/mmol (300 mg/g) or more, the A3 category. NICE uses a higher level in some situations, or a lower level when blood is also found in the urine.
• eGFR is falling quickly. A large, sustained drop over months or within a year, rather than a small change between two tests, is a common reason for referral.
• Blood and protein are both found in the urine and continue on repeat testing, without another explanation such as an infection. This can point to inflammation of the kidney filters.
• Blood pressure stays high despite several medicines in someone with kidney disease. NICE describes this as blood pressure that stays uncontrolled on four or more medicines.
• An inherited or rare kidney condition is known or suspected, for example polycystic kidney disease or a strong family history of kidney failure.
• Potassium or other minerals stay abnormal, or kidney stones keep coming back in someone with kidney disease.
• The estimated risk of kidney failure is high. Some doctors use a tool called the Kidney Failure Risk Equation, which combines age, sex, eGFR and ACR.
• Kidney failure treatment needs planning, such as preparing for dialysis or being assessed for a kidney transplant.

A doctor may also refer when a sudden kidney injury has not recovered as expected, or simply when they want a specialist opinion on an unusual result.

Who else can look after kidney results?

Many people with CKD stages G1 to G3 and mildly raised ACR are looked after well by a GP or an internal medicine physician. That usually means regular eGFR and ACR checks, blood pressure and blood sugar control, and a review of medicines that can affect the kidneys. If you have diabetes or high blood pressure, your usual doctor may already be checking your kidneys once a year or more.

What if you don't have a referral?

In Mombasa, some specialist clinics accept people who book directly, while others ask for a referral letter. Some insurance schemes also need a referral or pre-authorisation before they cover a specialist visit. It is worth asking about both when you call.

If you have a worrying result but no referral, these steps help:

• See a GP or internal medicine physician first. They can repeat tests, add a urine ACR if it was not done, and write a referral if needed.
• Gather your results in date order. A single result is hard to interpret. A series over several months tells a much clearer story.
• Use our guide on what to do after a high creatinine result to understand the usual next steps.
• If you are unsure which service to start with, try the Not sure what you need? pathway.

Seeing a specialist without a referral is not wrong. It can simply mean the first visit is spent repeating basic tests that a GP could have arranged.

Common questions

Can I see a nephrologist without a referral in Mombasa?

Some specialist clinics in Mombasa accept direct bookings and some ask for a referral letter. Insurance schemes may also need a referral or pre-authorisation. Ask the clinic and your insurer before booking.

Does a high creatinine result mean I need a nephrologist?

Not on its own. Creatinine is used to calculate eGFR, and doctors look at eGFR together with urine ACR and how results change over time. Many people with a raised creatinine are first assessed by a GP or physician.

Will I have to keep seeing the nephrologist forever?

Not always. Some people see a nephrologist once or a few times for a plan, then continue checks with their usual doctor. Others with more advanced kidney disease stay under regular specialist care.

This page explains what kidney care involves in general terms. It is not a diagnosis and does not replace advice from a doctor who knows your history. Your results should be interpreted together with your symptoms, other tests and a clinical assessment. Medical disclaimer.