Older patients in the nephrology clinic--should they be referred?

The New Zealand medical journal

PubMedID: 16286936

Lynn S, Sainsbury R, Searle M. Older patients in the nephrology clinic--should they be referred?. N Z Med J. 2005;118(1225):U1728.
AIM
To review the outcomes of elderly patients referred to a nephrology clinic and to develop referral guidelines.

METHODS
A retrospective audit of patients aged 65 years or older referred over a 24-month period to a nephrology clinic. Outcomes assessed were whether a renal diagnosis was made and if there was any change in management.

RESULTS
Sixty-one patients were referred with an average age of 74 years (range 65-88 years). The commonest reason for referral was renal impairment (69%); mean estimated creatinine clearance 32 ml/min. Diagnoses included hypertensive renal disease (30%), chronic renal failure - cause unknown (18%) and diabetic nephropathy (8%). In the majority of cases, the diagnosis was clinical. Renal biopsy was performed on four patients and declined by a further two. Management usually consisted of advice regarding clinical monitoring and drug treatment (80%). The clinic visit resulted in a change of management in 50% of cases.

CONCLUSIONS
Most elderly patients with renal disease have chronic pathology for which intensive investigation is not warranted. The majority of nephrology clinic referrals resulted in advice on clinical management being given to the general practitioner. Patients with severe or acute renal impairment are more likely to be investigated and offered treatment. Referral guidelines for general practitioners may aid appropriate referral.