Category: All Referrals

Urology, Suspicion of Cancer Referral

Scott McLaughlin
Urological cancers
Prostate cancer

Prostate cancer is the most common cancer in males in Scotland, with approximately 2,800 new cases diagnosed every year. Risk increases with age and approximately 99% of cases are diagnosed in men aged over 50 years. Men are 2.5 times more likely to be diagnosed with prostate cancer, if their father or brother has had it. In the UK, the lifetime risk of prostate cancer in Black men (1 in 4) is double that of the lifetime risk of all men combined (1 in 8).

Men presenting with unexplained possible symptoms and signs suggestive of prostate cancer such as changes to urinary patterns, erectile dysfunction, haematuria, lower back pain, bone pain or weight loss should have a digital rectal examination and a prostate specific antigen (PSA) test with counselling. A PSA test should not be performed within 1 month of a proven urinary tract infection (UTI). It should be noted that the majority of men with prostate cancer have no symptoms at all.

Bladder and kidney cancer

Visible haematuria is the most common presenting symptom for both bladder and kidney cancer. Other presenting features include loin pain, renal masses, non-visible haematuria, anaemia, weight loss and pyrexia. Both cancers are uncommon, with around 800 new bladder and 860 new kidney cancers each year.

Testicular and penile cancer

Although scrotal swellings are a common presentation in general practice, testicular cancer is relatively rare, with around 200 new cases per annum, of which approximately 70% are between 15 and 45 years. Solid swellings affecting the body of the testis have a high probability (>50%) of being due to cancer. Cancer of the penis is rare, with around 60 new cases each year in Scotland, but its incidence is rising.

All patients presenting with symptoms or signs suggestive of urological cancer should be referred to a team specialising in the management of urological cancer, depending on local arrangements.

Urgent suspicion of cancer referral

Prostate cancer

Evidence from digital rectal examination of a hard, irregular prostate

Elevated or rising age-specific PSA. Rough guide to normal PSA levels:

  • men less than 60 years – less than 3ng/ml
  • men aged 60 – 69 years – less than 4ng/ml
  • men aged 70 years and over – less than 5ng/ml

Bladder and kidney cancer

  • Patients with painless visible haematuria
  • Patients with non-visible haematuria and symptoms suggestive of UTI but with sterile mid-stream urine (MSU)
  • Abdominal mass identified clinically or on imaging that is thought to arise from the urinary tract

Testicular and penile cancer

  • Swelling in the body of the testis
  • Suspicious scrotal mass found on imaging
  • Men considered to have epididymo-orchitis or orchitis which is not responding to treatment
  • Any non-healing lesion on the penis or painful phimosis

Non urgent referral

  • Elevated age-specific PSA where urgent referral will not affect outcome due to age or comorbidity
  • Asymptomatic persistent non-visible haematuria without obvious cause
  • Patients over 40 who present with recurrent UTI associated with any haematuria

Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 85 – Management of transitional cell carcinoma of the bladder
Clinical Lead: Mr Rehan Khan, Consultant Urology Surgeon, NHS Lanarkshire
Review Date April 2017

Urology General Referral

Scott McLaughlin

The introduction of cancer and general diagnostic waiting time targets have lead us to look at how we can better deal with referrals to the urology departments in Lanarkshire and so minimise waiting times.

Patients with suspected urological malignancy should be referred through the SCI Gateway, Lanarkshire Cancer Referral Services These conditions include:

  • Palpable renal mass
  • Incidental renal tract mass on radiology
  • Frank haematuria
  • Symptomatic occult haematuria
  • A scrotal lump which cannot be sparated from testes
  • Suspected prostate cancer because of abnormal rectal examination or PSA outwith the age reference range
  • Suspected penile tumour

All other referrals should be marked Routine. An explanation in the text of the referral such as chronic retention or severe colic will be treated urgently, even if marked routine. Referrals for conditions other than described above marked urgent may be down graded to routine.

The following referral guidelines are based on specific presentations likely in general practice. Not all patients will fit these broad categories, but we hope the suggestions will ease the initial decision in many cases.

PresentationPreparation and Initial Management
Asymptomatic non visible haematuriaIf dipstick positive, send same sample for microscopy. Casts or abnormal forms indicate requirement for referral to renal physician. Investigate if 2+, or if consistently 1+ (as defined as 2 out of 3 samples) On flow cytometry of MSU, 1+ is defined as 40-100 rbc, 2+ is 100-250 rbc. Arrange MSSU. BP. biochemistry/haematology bloods. Book USS. Patient will be booked for direct access flexible cystoscopy. Manage positive results as indicated.
Symptomatic non visible haematuria In patients < 40 yrsMSSU, BP Biochemistry/Haematology bloods, USS with post-mic residual. Patient will be booked for direct access flexible cystoscopy. Treat/refer positive results as indicated.
Testicular Lump If lump distinctly separate and feels benign, then can be treated symptomatically. USS of scrotum if uncertain or there is a lot of anxiety. If patient fit and symptoms justify surgery refer to general urology clinic. In Wishaw and Monklands there is a separate scrotal lumps clinic for rapid assessment of all such lumps, but not non specific pain.
Testicular Pain Examine for local causes including rectal. Check MSSU. Think of referred causes. If negative reassure. If suspicion or anxiety persists, arrange ultrasound. If normal reassure. Urological referral unlikely to be useful but if in doubt, Patient will be seen at the general urology clinic.
Positive uti in male SIGN guidelines suggest men should be investigated if they have symptoms of upper tract infection, fail to respond to antibiotics or have two or more episodes in three months MSSU, BP, Biochemistry/Haematology bloods. Arrange an USS+KUB with post micturation residual. Patient will be booked for direct access flexible cystoscopy.
Recurrent cystitis in female / urinary tract infection in females Persisting pyuria There are no clear guidelines for investigation. In young males, consider urethritis/ STI. In all, consider atypical infection. Check 3 EMUs. In over 40s, it may be worth excluding underlying abnormality. BP, biochemistry/haematology bloods. Book USS, with post-micturation residual. The patient will be booked for direct access flexible cystoscopy.
Persisting pyuria Although there are no specific SIGN guidelines for referral, indications for referral could be as for males.MSSU, BP, Biochemistry/Haematology bloods. Book an USS, with post-mic residual. In those < 40 yrs, that may be enough but, if troublesome and in those > 40. The patient will be booked for direct access flexible cystoscopy.
Haematospermia Chlamydia urine (white top container) in younger patient MSSU. PR/testicular exam to exclude obvious malignancy Check PSA in older age group. Dipstick urine for haematuria. Trial of quinolone for 2 weeks if investigations negative. Patient will be booked for routine general urology clinic only for difficult cases.
Suspected stone disease MSSU, BP, Biochemistry/Haematology bloods, Arrange USS. If abnormal or history highly suggestive despite negative result. Patient will be booked for routine general urology clinic appointment.
Outflow obstruction in males > 50 yrs MSSU, BP, Biochemistry/Haematology bloods. Fill in symptom score and fluid chart. For mild/ moderate symptoms give trial of alpha blocker. If fails to respond or symptoms severe patient will be booked for prostate clinic.
Stress incontinence Examine for distended bladder/ pelvic mass. MSSU Address concomitant factors such as obesity, smoking. Refer for physiotherapy with pelvic floor exercises/ interferential bladder training. Refer to Continence Advisory Service, Lomond Road, Coatbridge, ML5 2JN.
Overactive bladderExamine for distended bladder / pelvic mass. MSSU. Address concomitant factors such as obesity, smoking, fluid / caffeine intake. Fluid balance chart. Refer to physiotherapy for bladder exercises. Consider trial of anti-cholinergic. If fails conservative management, refer to Continence Advisory Service, Lomond Road, Coatbridge, ML5 2JN.
Erectile dysfunctionCheck routine bloods including PSA and testosterone. Look at lifestyle and general issues such as obesity, smoking / alcohol intake, general fitness, medication and other diseases such as vascular, neurology, diabetes and psychology. Manage as appropriate. Next line of treatment if patient wishes this is with phosphodiesterase inhibitors such as Viagra/ Cialis/ Levetra. If this fails despite 8 doses, try another PDE5 inhibitor. If still fails or is contra-indicated and patient wishes to be considered for more interventive treatment, Patient will be booked for E.D clinic. If significant psychological component, consider referral to clinical psychologist.
Peyronies DiseaseThis may present with a penile lump and erectile deformity. There is no overlying skin problem.

There may be an acute phase with pain and a changing deformity that may last up to a year. This phase can be treated symptomatically. It may be worth a trial of phosphodiesterase inhibitor for flaccidity.

Once this has been settled, if the degree of penile deviation is such to make penetrative intercourse difficult enough to justify surgery with the side effects of penile shortening and impotence, refer routinely to general urology clinic.
Family planningWe do not offer a vasectomy reversal service. If a patient requests a vasectomy for family planning, they should be referred to local services , or to Sandyford Place in Glasgow for a local anaesthetic procedure. If a patient is deemed unsuitable by Sandyford place for a local anaesthetic procedure on medical grounds, and not just preference, they can be referred for a general anaesthetic vasectomy to the general urology clinic.
Paediatric conditions The lower age limit for the urology service is thirteen years. We will see referrals above this age with mainly surgical conditions such as phimosis, and inguino-scrotal problems. The paediatricians will continue to see referrals upto fifteen with medical conditions such as uti, abdominal pain, enuresis. Surgical problems in children below thirteen years old can be marked paediatric surgery and sent to J McGowan, who is the secretary in Wishaw to the eye dept and the paediatric surgeons (Mr M. Flett and Mr Walker). Emergency cases in children upto thirteen should be directed to Yorkhill.

Stop Smoking Service Guidelines

Scott McLaughlin

Stop Smoking Service Referral

This referral is for use by dentists to refer patients to the NHS Lanarkshire Stop Smoking Service.

Please make your patient aware of the following note:

Your information will be stored on a Stop Smoking Service database and held securely by NHS Lanarkshire, this information will be used only in connection with this service. Anonymous information may be used for statistical and audit purposes.

Stop Smoking Service OfficeCo-ordinatorsAreas Covered
Glenalmond Building
Coathill Hospital
Hospital Street
Coatbridge
ML5 4DN

Tel: 01236 707714
Fax : 01236 707742 		Catherine BrownNW Locality
Coatbridge, Cumbernauld, Kilsyth and Airdrie.
Netherton House
94-104 Netherton Street
Wishaw
ML2 0DZ

Tel: 01698 366979
Fax : 01698 366982		Maureen BrownNE Locality
Motherwell, Bellshill, Viewpark, Wishaw, Newmains, Harthill, Shotts, Newarthill
Udston Hospital
Farm Road
Hamilton
ML3 9LA

Tel: 01698 723233
Fax : 01698 723133 		Jacqueline MacDonaldSouth Locality
Hamilton, Blantyre, East Kilbride, Larkhall, Uddingston, Bothwell, Carluke, Lanark and Clydesdale Areas, Rutherglen, Cambuslang, Strathaven, Harthill, Shotts, Newarthill

Skin, Suspicion of Cancer Referral

Scott McLaughlin
Skin Cancers

Approximately 12,000 people are diagnosed every year with skin cancer in Scotland, of which around 1,200 are malignant melanoma and 3,000 are squamous cell carcinomas (SCC). The incidence of skin cancer is rising.

Risk factors for all skin cancer types include excessive sunlight exposure, sun bed use, fair skin and susceptibility to sunburn. For melanoma, a large number of benign melanocytic naevi and family history are risk factors. For SCC, multiple small actinic keratoses, high levels of previous UV-A photochemotherapy and immuno-suppression are also risk factors. Patients with multiple atypical naevi and a strong family history may have an increased risk of developing skin cancer. Skin cancers are very infrequent in people with dark skin and in children under 15 years.

Guides for assessment include the 7-point checklist and the ABCD (Asymmetry, Border irregular, Colour irregular, Diameter increasing) checklist SIGN Guideline 72 (Withdrawn Feb 2015/Under Review) – Cutaneous Melanoma. Some melanomas will have no major features.

The dermoscope is a useful tool for trained clinicians screening pigmented lesions as it can increase diagnostic accuracy.

Good practice points

  • Lesions which are suspicious for melanoma should not be removed in primary care. All excised skin specimens should be sent for pathological examination.
  • Lesions suspicious of basal cell carcinomas (BCC) may not require urgent referral, except those invading potentially dangerous areas.
  • Referrals should be accompanied by an accurate description of the lesion (including size, pain and tenderness) and photos if possible, subject to clinical governance arrangements, to permit appropriate triage.

A patient presenting with a skin lesion suggestive of cancer should normally be referred to a dermatologist, depending on local arrangements.

Urgent suspicion of cancer referral

Lesions on any part of the body which have one or more of the following features:

  • change in colour, size or shape in an existing mole
  • moles with ABCD (Asymmetry, Border irregular, Colour irregular, Diameter increasing or >6mm
  • new growing nodule with or without pigment
  • persistent (more than 4 weeks) ulceration, bleeding or oozing
  • persistent (more than 4 weeks) surrounding inflammation or altered sensation
  • new or changing pigmented line in a nail or unexplained lesion in a nail
  • slow growing, non-healing or keratinising lesions with induration (thickened base)
  • any melanoma or invasive SCC or high risk BCC diagnosed from biopsy
  • any unexplained skin lesion in an immuno-suppressed patient
  • BCC invading potentially dangerous areas, for example peri-ocular, auditory meatus or any major vessel or nerve

The department operates a photo triage system for Skin Cancer referrals. Please phone one of the numbers below to make an appointment for your patient with the Medical Photography department before making a referral. (Please do not delay the referral if there is a difficulty making the appointment)

Hairmyres Hospital: 01355 585497
Monklands Hospital: 01236 712129 or ask for Radio Page 527
Wishaw General Hospital: 01698 366443

Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 72 (Withdrawn Feb 2015/Under Review) – Cutaneous Melanoma
Clinical Lead (Vacant)
Review Date April 2017

Sexual and Reproductive Health – STI Referral

Scott McLaughlin

Sexual & Reproductive Health

The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.

The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.

There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.

There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.

There is a sexual health link on FirstPort under clinical service. This has links to protocols etc. Link to come

There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.

Notes

Symptoms suggestive of an acute sexually transmitted infection (STI) (urgent)
We aim to offer an appointment within 48 hours to all clients who have symptoms suggestive of an acute STI eg genital ulcers, new onset vaginal discharge, urethral discharge, pelvic pain, testicular pain. However, we may not be able to offer them an appointment in their local clinic within this time frame.
It may be quicker for the patient to call the appointment line themselves: 0845 618 7191

For treatment if already diagnosed with acute STI: (urgent)
The following link takes you to a list of the recommended treatments (assuming no contraindications.) Please see protocol available on FirstPort for further guidance.
List of the recommended treatments

Sexual contact with someone who as Chlamydia, Gonorrhoea, Syphilis, Trichomoniasis, Epididymo-orchitis or PID (urgent)

Sexual contact with someone who has HIV (urgent)
If exposure has occurred less than 72 hours, please refer urgently to A&E or d/w Infectious Disease Consultant On-call as patient may be eligible for Post Exposure Prophylaxis After Sexual Exposure (PEPSE)
The window period for HIV is 3 months but many HIV infections show up by 4 weeks post exposure. Initial blood test can be done at that time.

Sexual Assault (urgent)

Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway: Telephone: 0141-211-8175
The forensic examination can be carried out whether or not the woman or man wishes police involvement.
If the assault took place more than 7 days ago, the patient can be seen within sexual health for STI screening, Hepatitis B vaccination and further management.
We do NOT offer forensic examination.

Genital warts (routine)

If appropriate, please prescribe topical treatments in the first instance. Only cryotherapy can be used in pregnancy. If Podophyllotoxin has been ineffective after 4 weeks of use, please advise patients to attend a sexual health clinic. If Imiquimod has been ineffective after 4 weeks of use please ask patient to attend a sexual health clinic. However, if Imiquimod has started to take effect further treatments can be prescribed (maximum of 16 weeks in total).
It is good practise to offer an STI screen to all patients attending with genital warts.

Recurrent genital herpes (routine)

A HSV positive swab is required to confirm diagnosis prior to initiation of antiviral prophylaxis.
Suppressive antivirals are usually started in patients who have greater than 6 outbreaks of HSV/ per year.

Asymptomatic testing for STIs (routine)

This can usually be offered within Primary Care. For a male, a First void urine (after having not passed urine within the past hour) into a white topped universal container can be sent for Chlamydia and Gonorrhoea testing.
For females, a self obtained low vaginal swab (patient inserts swab 5cm into the vaginal and rotates for 15 seconds before placing it into container) can be sent for Chlamydia and gonorrhoea testing. Urine is not a good method of testing for these infections in women.
Blood samples can be sent in two yellow top tubes to microbiology for HIV and Syphilis testing.

Blood Borne Virus testing – Hepatitis B, C and HIV (routine)

This can usually be offered within Primary Care by sending 3 blood samples in yellow top tubes to microbiology.

Hepatitis B Immunisation (may need urgent referral depending on reason for referral)

We offer Hepatitis B Immunisation for the following groups :

  • Sexual assault within past 6 weeks
  • Post or pre sexual contact with someone who has Hepatitis B
  • Men who have sex with Men
  • Sex workers
  • Clients who have regular contact with sex workers
  • IVDU
  • Partners of IVDUs
  • Clients with multiple partners

We do not offer hepatitis B immunisation for travel purposes.

Sexual and Reproductive Health – Partner Notify

Scott McLaughlin

Sexual & Reproductive Health

The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.

The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.

There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.

There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.

There is a sexual health link on FirstPort under clinical service. This has links to protocols etc. Link to come

There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.

Sexual and Reproductive Health – Contraception

Scott McLaughlin

Sexual & Reproductive Health

The departments of Sexual & Reproductive Health (formerly known as Family Planning) and Genitourinary Medicine merged in 2008 and are now known as the department of Sexual Health.

The administrative base is at Glenalmond House, Coathill Hospital, Coatbridge ML5 4DN and there are clinics every day across Lanarkshire. Most clinics are combined clinics and patients can be see and managed in a single clinic with both Genitourinary Medicine and contraceptive consultations.

There are still a few traditional Family Planning/Sexual & Reproductive Health clinics dealing with contraception mainly.

There is a dedicated appointment line which patients or GPs can refer into: 0845 618 7191.
This is open 9am – 4.45pm Monday to Friday.

There is a sexual health link on FirstPort under clinical service. This has links to West of Scotland Protocols

There is also a public website, Lanarkshire Sexual Health, which has up to date information on all clinics and on contraception and sexual transmitted infections.

Contraception Referral Notes:

Chlamydia testing in women requesting Intrauterine Contraception

It is good practice to perform a Chlamydia test prior to fitting an Intrauterine Device in women under the age of 25 years and women over 25 years old with a new sexual partner in the past year or more than 1 partner in the last year or if their regular partner has other partners. A self obtained vulval vaginal swab for Chlamydia should be taken prior to referral. If this is not done, this will be done at the time of fitting of the device, however, it may be that the fitting of the device is deferred if the women has symptoms etc.

Additional Information

Patients who request an intrauterine system (IUS) for Gynaecological reasons and are not requiring contraception, should be referred to Gynaecology.

Patients on Nexplanon commonly get nuisance bleeding patterns. Patients with no contra-indications to the combined pill may use Combined Oral Contraceptive (COC) for up to three months while they have the Nexplanon in-situ, provided they have a pregnancy test which is negative. This is an off label use of the COC but is recommended by the Clinical Effectiveness Unit (CEU) of the Faculty of Sexual & Reproductive Health (FSRH).

The following priority conditions are not suitable for SCI Referral and women should self-refer via the Appointment Line: 0845 618 7191

Emergency Contraception

Women requiring emergency contraception can be prescribed Levonelle which is free in many community pharmacies in NHSL. Women presenting after 72 hours or more i.e. 72 hours since unprotected sexual intercourse can use oral emergency hormonal contraception called EllaOne. This works up to 120 hours after unprotected sex. EllaOne is available in the sexual health services or on prescription via the GP. As EllaOne is four times the price of Levonelle, it is only used between 72 – 120 hours after the unprotected sex. EllaOne can be used in young (under 16’s) vulnerable chaotic clients who are mid cycle and who do not wish an Intrauterine Device (IUD).

Women who wish the most effective method of emergency contraception need counselled re-fitting of an Intrauterine Device (IUD) as this is 99% effective in preventing pregnancy. An IUD can be fitted up to five days after unprotected sexual intercourse or up to five days after the earliest possible ovulation (i.e. up to day 19 on a 28 day cycle).

The Protocol for Emergency Hormonal Contraception is available on West of Scotland Protocols website, where you can also view the Emergency Hormonal Contraception protocol.

Termination of Pregnancy

Women who require a termination of pregnancy can be referred to the Sexual Health Service where the GP does not offer referral to women’s health unit. They will be seen within 48 hours if they ask for an emergency appointment.

Recent Sexual Assault (within last 7 days)

Women or men who make an allegation of sexual assault within the last seven days should be encouraged to self refer to Archway:

Telephone: 0141-211-8175

The forensic examination can be carried out whether or not the woman or man wishes police involvement.

Renal Referral Guidelines

Scott McLaughlin
Renal MedicineConsultantDirect Line to Secretaries
Monklands HospitalDr W. G. J. Smith01236 712640
Monkscourt AvenueDr M. F. Hand01236 712641
AirdrieDr I. R. Shilliday01236 712582
ML6 0JSDr J. P. Traynor01236 713167
Switchboard01236 748748
Fax Number01236 712179

Background

The renal unit is mostly centred at Monklands although we have some clinics at Wishaw and Hairmyres. It is likely that your patient will be reviewed at Monklands first. Background info on the renal unit is available via the FirstPort website. This also includes access to our guidelines including CKD guidelines and advice on the use of ACE inhibitors and ARBs. These are held in the Renal Documents Library on FirstPort

Referral Process

We have two categories of referral – routine and urgent. A routine patient will be seen in approximately 9 weeks. An urgent referral should be made if you think the patient may need to be admitted and we would prefer the urgent referral is coupled with a phone call at the time of referral to discuss the case.

Reasons for Referral

For outpatient review (or at least discussion) include:

  • Stage 4 and 5 CKD (i.e. eGFR < 30 ml/min on two measurements three months apart)
  • Significant proteinuria i.e. ACR > 70 (or > 30 if under 55 years)
  • Difficult to control hypertension
  • Stage 3 CKD if under 55 years old or > 10ml/min loss of renal function over a 12 month period
    To make the first visit much more meaningful it would therefore be extremely useful if the following investigations could be ordered at the time of referral (unless already available):

Essential

  • Renal ultrasound – (Please refer all patients unless they have had a recent scan via Clinical Radiology to HH, MDGH and WGH on SCI Gateway. Choose the option Renal Scan- referred to renal clinic)

This will then trigger an USS which will include Renal size, renal cortex, aorta and presence or absence of hydronephrosis. If hydronephrosis is found, then a bladder USS will be undertaken.

If a renal mass is found, radiology will automatically self refer for CT and access the lab browsers for the eGFR (blood for this should have been taken as part of the renal referral process). Information regarding diabetes and metformin use should be included in the referral

The initial report will be sent to primary care as if there is a mass or obstruction this should be referred through to Urology. Renal team will have direct access to the reports in clinic so do not need the reports forwarded. With a clinic waiting time of 6-8 weeks, the USS will always be done before the patient is seen in clinic

Bloods

  • Renal Profile( Request RENP), CRP, FBC. ( RENP=UE (including Bic), bili, ALT, AST, ALP, GGT, Ca, Alb, PO4)

Urine

  • Urine for Albumin/Creatinine Ratio (the labs accept the abbreviation ˜ACR)

Non Essential

  • All ages ‘vasculitic screen’
  • Rheumatoid factor (RF), anti-nuclear antibodies (ANA), ANCA and C3 C4

If over 40 years old

  • Serum electropheresis and immunoglobulins (can be requested SEP and IgGs on the request form) and urine for Bence Jones protein (BJP)

On the main referral page several items are coded as mandatory fields. We hope you will be willing to put up with the minor frustration this might cause you to ensure that our mutual patient’s journey through the clinic system is made as meaningful and quick as possible.