At your first nephrology appointment, a kidney specialist usually reviews your health history, medicines and recent test results, examines you, and may order blood, urine or imaging tests. The aim is to understand what is going on with your kidneys and agree on next steps. A little preparation, such as gathering lab reports and writing down questions, helps you leave with clear answers.
Key Takeaways
- People are often referred because a blood test, urine test or blood pressure reading suggests the kidneys need a closer look.
- In most cases you need a referral from your primary care doctor, but it depends on your insurance plan, so check before you book.
- Bring your medicine list or bottles, insurance cards, photo ID, pharmacy details and copies of recent lab and imaging results.
- The first visit is mostly a conversation and an exam, and it may lead to blood tests, urine tests or an ultrasound.
- Writing your questions down ahead of time, such as what stage you are in and what is causing it, helps you get the most from the visit.
Why Would Your Doctor Refer You to a Nephrologist?
A nephrologist is a doctor who specializes in the kidneys. For more on their role, see what a nephrologist does and when you need one. Common reasons for a referral include:
- A low or falling eGFR (estimated glomerular filtration rate), a blood test result that shows how well your kidneys filter
- Protein or blood that keeps showing up in your urine
- Blood pressure that stays above your goal even on several medicines
- Diabetes or high blood pressure, the two most common causes of kidney disease, along with kidney changes on your tests
- Kidney stones that keep coming back, or kidney disease in your family
A referral is a request for a specialist’s opinion. By itself, it does not tell you how serious things are; sorting that out is part of what the first visit is for. Feeling nervous is common, and early care is worth it: the sooner kidney disease is treated, the more likely it can be slowed or kept from getting worse.
Do You Need a Referral to See a Nephrologist?
Usually, yes. In most cases, you need a referral from your primary care doctor to see a nephrologist, but it may depend on your insurance plan. A referral is a written order from your primary care doctor for you to see a specialist. In many HMO plans, the plan may not pay if you skip that step.
Before you book, call the member services number on your insurance card. Ask whether you need a referral and whether the nephrologist is in your network. Then ask your primary care office to send the referral and your recent lab results, so the specialist has them before you arrive.
What Should You Bring to Your First Appointment?
If your visit is with ANC, plan to arrive 15 minutes early to complete paperwork. The registration form, HIPAA form, privacy notice and patient packet are on the new patient page if you want to look them over first. Bring:
- A list of your current medicines and dosages, or the prescription bottles themselves
- Your insurance cards
- A driver’s license or other photo ID
- Your pharmacy information
It also helps to bring copies of recent blood and urine results and any imaging reports, especially from outside labs. If you check your blood pressure at home, bring your cuff and several days of readings. A short symptom diary, notes on your family’s health history and the names of your other doctors are useful too.
Why Does Your Full Medicine List Matter So Much?
When your kidneys do not filter as well as they used to, some medicines can build up in your blood to unsafe levels, and others can harm the kidneys directly. That is why the nephrologist wants to see everything you take, including over-the-counter medicines, vitamins and supplements.
Common pain relievers and cold medicines called NSAIDs, such as ibuprofen and naproxen, can damage the kidneys. Ask your doctor or pharmacist whether the products you use are safe for you. Do not stop or change a prescribed medicine on your own; bring your questions to the visit instead.
What Usually Happens During the Visit?
Much of the first visit is talking. A medical assistant or nurse may collect some information first. The nephrologist will then review your records and ask about your symptoms, other health conditions, family history and medicines. A physical exam follows, which usually includes a blood pressure check.
Next, the nephrologist may order tests. These often include blood tests of kidney function, such as eGFR and creatinine, and urine tests that look for protein (albumin) or blood. Some people also have imaging, such as a kidney ultrasound. You may be asked for a urine sample when you arrive, so it is fine to call ahead and ask what to expect. To make sense of the numbers, see our guide to what kidney function test results mean.
What Questions Should You Ask Your Kidney Doctor?
It is easy to forget a question once you are in the exam room, so write yours in a notebook and bring it. Good questions include:
- Why was I referred, and what is causing my kidney problem?
- What stage of kidney disease am I in, and what does that mean?
- What are my eGFR and urine albumin results, and have they changed?
- How quickly is my kidney function changing, and what can I do to slow it down?
- Do any of my medicines need to change, and are there any I should avoid?
- Do I need to change what I eat?
- How often should I come back, and when is my next lab test?
- Who should I call with new problems or questions?
Bringing a trusted family member or friend can help. They can take notes, ask questions and remind you about follow-up visits.
What Happens After Your First Nephrology Visit?
You will usually leave with next steps, even if some answers wait on test results. These may include follow-up blood and urine tests, a return visit, and ways to protect your kidneys, such as meeting a blood pressure goal, managing blood sugar if you have diabetes, or changing medicines or diet. Your nephrologist and primary care doctor may work together on your care.
For many people with chronic kidney disease, the goal is to keep eGFR the same and urine albumin the same or lower. Our article on CKD stages and whether kidney function can improve explains more. If you feel unsure about the plan, getting a second opinion is a normal step.
When Should You Get Care Before Your Appointment?
Do not wait for a scheduled visit if something urgent happens. Call 911 or go to the emergency room if you have:
- Chest pain or discomfort
- Trouble breathing or shortness of breath
- Sudden confusion, fainting or trouble staying awake
- Sudden, severe pain anywhere in your body
Call your primary care doctor or the nephrology office right away if you are making much less urine than usual or none at all, or if new swelling appears in your legs, ankles or feet. For changes that are new but not urgent, such as foamy or darker urine or trouble focusing, call and ask whether you should be seen sooner.
Frequently Asked Questions
Can I See a Nephrologist Without a Referral?
Sometimes, but it depends on your insurance plan. Many HMO plans require a referral first, so call your plan before you book.
Will I Have Blood Drawn at My First Visit?
You may. Nephrologists often order blood and urine tests, and some offices ask for a urine sample at the start of the appointment.
Can I Bring Someone With Me?
Yes. A family member or friend can take notes, ask questions and help you remember the plan afterward.
Does Seeing a Nephrologist Mean I Will Need Dialysis?
Not necessarily. Nephrologists also look for the cause of kidney changes and treat early stages, when there is more chance to slow things down. If dialysis is on your mind, ask about it directly.
Will I Still See My Primary Care Doctor?
Usually, yes. Your primary care doctor may keep helping you manage conditions like diabetes and high blood pressure while working with your nephrologist.
What If I Do Not Understand My Results?
Ask your care team to explain them in plain words and to compare them with your last results each time you are checked.
Talk to ANC About Your First Visit
ANC’s physicians, nurse practitioners and physician assistants see patients with all types of acute and chronic kidney disease. If you have questions about a referral, scheduling or what to bring, Contact ANC or call 651-772-6251, Monday to Friday, 8:30 AM to 4 PM.
Sources
- National Kidney Foundation: Your First Visit with a Kidney Doctor
- Cleveland Clinic: What Is a Nephrologist? When To See One and What To Expect
- NIDDK: Managing Chronic Kidney Disease
- NIDDK: Chronic Kidney Disease Tests and Diagnosis
- HealthCare.gov: Referral
Medical Disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your specific care and treatment options.
