Nephrology Inpatient Consultation Note

Date/Time of Service: [Date and time of encounter]

Consulting Service: Nephrology

Requesting Service/Clinician: [Service and clinician name]

Patient Location: [Unit/bed]

Reason for Consult: [Kidney-focused reason(s) prompting nephrology evaluation]

Source of History: [patient / family / chart / outside records] (Note any limitations such as altered mental status, intubation, or language barrier.)

Allergies: [List each agent with reaction type] (If not confirmed, state: "Unknown / not available")

Consult Question

[Restated consult question with prioritization and time sensitivity] (Summarize in 1–3 lines. If unclear, state what clarification was sought.)

Patient Summary

[Age] [sex/gender] with [major comorbidities] and [baseline creatinine with date/source or CKD stage; state "unknown baseline" if not available], admitted for [reason for admission], now with [current nephrology problem].

History of Present Illness

Kidney trajectory: [Baseline creatinine with date/source] (If unknown: "Baseline creatinine unknown—[records requested / unable to obtain].") [Creatinine trend since admission with dates/times], [urine output summary with timeframe; specify oliguria/anuria if present], [catheter status], [hemodynamic/volume course including hypotension episodes, pressors, fluid resuscitation, diuretic trials], [net fluid balance and weight change with timestamps].

Exposure review: [Recent and chronic nephrotoxin exposures: NSAIDs, ACEi/ARB, diuretics, aminoglycosides, vancomycin, contrast, calcineurin inhibitors, PPIs, supplements, illicit drugs], [contrast exposure history or planned imaging], [obstruction risk factors: BPH, stones, malignancy, catheter issues], [rhabdomyolysis risk factors], [systemic disease clues: rash, fevers, arthralgias, sinus symptoms, hemoptysis].

Targeted symptoms: [Volume overload symptoms: dyspnea, orthopnea, edema], [uremic symptoms: confusion, nausea, pericarditis], [urinary symptoms: hematuria, foamy urine, flank pain], [electrolyte-related symptoms: weakness, palpitations, paresthesias]. (If patient cannot provide history, state limitation and sources used.)

Kidney-Relevant Past History

(Include only applicable subsections; omit those that do not apply.)

Chronic Kidney Disease

[CKD stage and presumed etiology], [proteinuria history], [prior nephrology care], [prior imaging findings], [prior biopsy results], [prior AKI episodes and recovery].

Dialysis History

[Modality and schedule], [last treatment], [dry weight], [access type/location/status], [dialysis unit contact]. (If dialysis status uncertain: "Dialysis status: unclear—confirming with chart/family/outside unit.")

Transplant History

[Transplant date], [baseline graft function], [rejection history], [current immunosuppression and recent levels], [viral complications].

Medications

Home Medications: [Kidney-relevant agents: ACEi/ARB, diuretics, SGLT2 inhibitors, metformin, NSAIDs, anticoagulants, immunosuppressants], [adherence certainty].

Inpatient Medications: [Nephrotoxin exposures with start dates], [current IV fluids type/rate], [diuretics with dose/route/timing], [electrolyte treatments already administered]. (When recommending changes, specify drug, rationale, and criteria to restart.)

Pertinent Social and Family History

[OTC analgesics], [supplements], [alcohol/tobacco/illicit drug use], [occupational exposures], [family history of kidney disease]. (Include only if relevant to the kidney differential; omit this section entirely if not contributory.)

Review of Systems

• [Volume/uremia screening positives and negatives]
• [GN/AIN screening: rash, arthralgias, fevers, sinus symptoms, hemoptysis]
• [Urinary symptoms]

(If HPI thoroughly covers relevant systems or patient cannot participate, state "ROS unobtainable due to [reason]" and omit the list.)

Physical Examination

• Vitals: [BP trend], [orthostatics if assessed], [HR], [RR], [Temp], [SpO2 and O2 delivery]
• General: [Appearance, mental status]
• Volume Assessment: [JVP], [peripheral edema], [pulmonary crackles], [mucous membranes], [skin turgor], [capillary refill]
• Cardiovascular/Pulmonary: [Findings relevant to congestion or perfusion]
• Abdomen: [Flank/CVA tenderness], [bladder distension]
• Skin: [Rash, purpura, livedo] (Note findings suggesting AIN or vasculitis)
• Access Exam: [HD access thrill/bruit], [catheter site condition] (Include only if applicable)

(If exam is limited, state the limitation and reliance on objective data.)

Objective Data

Vitals, Intake/Output, and Weights

• [Last 24-hour intake/output and net balance; cumulative net since admission]
• [Urine output summary with timeframe; include mL/kg/hr in ICU settings]
• [Daily weight and change from admission]

Laboratory Studies

• BMP/CMP: [BUN, creatinine, Na, K, Cl, HCO3, Ca, Mg, Phos] (Highlight trend and rate of change.)
• CBC with differential: [Hgb/Hct, WBC, Plt; note eosinophilia if present]
• Acid-base: [ABG/VBG with pH/PaCO2/HCO3], [lactate if relevant]
• CK: [Value/trend] (Include only if rhabdomyolysis suspected)
• Urinalysis: [Dipstick summary], [microscopy: RBC morphology, casts, crystals] (If microscopy not performed and clinically indicated, note this.)
• Urine chemistries: [Urine Na, Osm, Urea], [FeNa/FeUrea with notation of confounders such as diuretics or CKD]
• Proteinuria quantification: [UPCR/UACR] (Include if relevant)

Imaging

• [Renal ultrasound: hydronephrosis, kidney size, echogenicity]
• [Contrast exposure details and timing relative to kidney injury]
• [Echocardiogram findings if cardiorenal syndrome suspected]
• [Bladder scan/post-void residual if obstruction concern]

Serologies

[Ordered/resulted tests with dates: complements, ANA, ANCA, anti-GBM, hepatitis/HIV serologies, SPEP/free light chains] (Include only if ordered or being recommended; state clinical indication.)

Assessment and Recommendations

Impression: [AKI presence and KDIGO stage or CKD status], [most likely etiology category with explicit uncertainty], [immediate threats: hyperkalemia, acidosis, volume overload, uremic symptoms], [dialysis status and current need]. (3–5 sentences summarizing the clinical picture.)

(Include only problems that apply to this patient; remove unused problem sections and renumber.)

1. Acute Kidney Injury

   Assessment: [KDIGO stage and timing], [working diagnosis and supporting evidence], [reversibility assessment], [key uncertainties].

   • Diagnostics: [Urine microscopy, urine chemistries, renal ultrasound, targeted serologies with timing/urgency]
   • Hemodynamics/Fluids: [MAP target], [fluid strategy], [diuretic strategy if volume overloaded]
   • Medications: [Hold/avoid nephrotoxins], [renal dose adjustments], [criteria to resume held medications]
   • Monitoring: [BMP frequency], [strict I/O with UOP targets], [daily weights]

2. Electrolyte Disorder

   Assessment: [Disorder and severity], [ECG findings if applicable], [temporizing measures administered].

   • Plan: [Definitive therapy with doses], [recheck timing], [dietary restrictions], [medication adjustments]

3. Acid-Base Disorder

   Assessment: [Primary disorder], [compensation adequacy], [likely etiology].

   • Plan: [Treatment approach], [escalation thresholds], [monitoring frequency]

4. Volume Status

   Assessment: [Hypervolemic / euvolemic / hypovolemic] with [supporting exam and objective data].

   • Plan: [Diuretic dosing and route], [adjuncts if needed], [ultrafiltration consideration], [fluid and sodium targets]

5. Kidney Replacement Therapy

   Assessment: [Indication status: indicated now / likely soon / not indicated], [specific indications if present], [preferred modality and rationale].

   • Plan: [Access needs], [modality and initial prescription], [urgency and consent status], [triggers for initiation if deferring]

6. Contrast Risk

   Assessment: [AKI/CKD status and eGFR], [imaging necessity and timing].

   • Plan: [Prophylaxis if indicated], [hold/restart guidance for high-risk medications], [benefit-risk statement], [post-contrast monitoring]

Communication and Follow-up

Communication: [With whom (name/service) and when direct discussion occurred].

Role: [Nephrology as consultant / Nephrology comanaging] (If comanaging, specify scope of orders nephrology will place.)

Follow-up: [Will follow daily / will follow every [frequency] / sign off after [criteria]].

Contingency Plan: [Explicit thresholds for calling nephrology: K ≥6.0 despite therapy, pH <7.2, worsening volume overload, anuria >12h, creatinine rising >X mg/dL/day].

Signature

[Clinician name], [Credentials]

[Date/Time signed] | [Contact information]