Pediatric Nephrology Consult Note (Inpatient)

Header

Date/Time of Note: [Date and time of documentation]

Date/Time Patient Seen: [Date and time patient evaluated]

Author/Role: [Clinician name and role/title]

Service: Pediatric Nephrology

Patient Location: [Unit/bed or care area]

Requesting Team: [Primary inpatient team/service]

Requesting Clinician: [Name and role]

Consult Type: [initial / follow-up]; [routine / urgent / stat]

Information Sources: [Sources used: parent/guardian, patient, bedside nurse, EHR review, outside records] (Note key limitations only when clinically important data are unavailable.)

Reason for Consultation

• [Primary kidney-related clinical question(s) as stated by requesting team] (Use requesting team wording when feasible. Limit to 1–3 bullets.)

Patient Summary

[Age] [sex] ([weight or dosing weight]) with [major renal and relevant systemic comorbidities], admitted for [reason for admission], hospital day [#], now with [nephrology issue prompting consult]. (One concise sentence; maximum two lines.)

History of Present Illness

[Time-anchored narrative of renal course] (Use time stamps. Include: trajectory of creatinine/BUN and urine output with time windows; key events affecting renal function such as hypotension, sepsis, surgery, contrast, nephrotoxins; baseline kidney function with most recent known baseline creatinine and date; known CKD, CAKUT, prior AKI, dialysis or transplant history; volume and perfusion history including intake pattern, losses, diuretics, pressors, boluses, weight trend; urinary symptoms and catheter or diaper use; hypertension context if applicable; and nephrotoxic exposures with timing and current status. If baseline creatinine or other key data are unknown, state explicitly and recommend retrieval.)

Past Medical History

• [Renal history: CAKUT, reflux/UTIs, stones, nephrotic/nephritic syndromes, prior biopsies, CKD stage, transplant status, dialysis access history]
• [Other comorbidities affecting renal risk or management: cardiac, hepatic, oncologic therapy, sickle cell, prematurity]

(Omit this section if no relevant history.)

Medications

Home Medications: [List with doses and frequencies] (Prioritize ACEi/ARB, diuretics, NSAIDs, calcineurin inhibitors, and other nephroactive agents.)

Current Inpatient Medications: [List with doses and frequencies] (Flag agents requiring renal dosing or monitoring. Do not infer dose adjustments unless renal function basis is documented.)

Nephrotoxin and Contrast Exposure Review

• [Nephrotoxin name, indication, start date, current dose, drug level if applicable, clinical necessity or alternatives if known]
• [Additional nephrotoxins as applicable]
• Multiple concurrent nephrotoxins: [yes / no]
• Contrast exposure: [Date/time, type (iodinated / gadolinium), prophylaxis if used]

(Omit this section if no nephrotoxic exposures.)

Allergies

• [Allergen — reaction type and severity]

Family and Social History

• [Family history: renal disease, stones, hearing loss, early hypertension]
• [Social determinants relevant to care or discharge: caregiver reliability, transportation, home BP monitoring feasibility]

(Include only if relevant to the nephrology consultation; otherwise omit.)

Physical Examination

• General: [Appearance, distress, perfusion]
• Volume Status: [Mucous membranes/tears, capillary refill, edema location and grade, lung exam for overload, hepatomegaly/ascites]
• Cardiovascular: [Heart sounds, pulses]
• Pulmonary: [Breath sounds, work of breathing]
• Abdomen: [Bladder distension, tenderness, CVA tenderness]
• Lines/Access: [Foley with placement date, central lines, dialysis catheter, nephrostomy tube, ureteral stent]
• Neurologic: [Mental status, focal deficits relevant to uremia or hypertensive emergency]

(Include only examined elements. If exam limited, state limitation explicitly.)

Vitals and Volume Data

Vitals: Temp [value], HR [value], RR [value], SpO2 [value], BP [value with site/position, method, cuff size appropriateness, interpretation vs pediatric percentiles]

Weight: [Current weight and date/time]; [Daily trend if volume concern]

Intake/Output (last [6 / 12 / 24] hours): Total in [value], Total out [value], Net [value]; Urine output: [value] mL/kg/hr over [time window]; [Other outputs: stool, emesis, drains, nephrostomy as applicable]

Laboratory Data

(Present trends for the last 3–5 time points when available.)

• Renal Function Trend: [Date/time — Cr: value, BUN: value] → [Date/time — Cr: value, BUN: value] → [most recent]
• Electrolytes: [Date/time — Na, K, Cl, HCO3, Ca, Mg, Phos values]
• Acid-Base: [ABG/VBG with pH, pCO2, HCO3; lactate if relevant]
• CBC/Albumin: [WBC, Hgb, Plt, Albumin values]
• Drug Levels: [Vancomycin, aminoglycoside, tacrolimus levels with goals if applicable]
• Immune Workup: [Complements, ANA, dsDNA, ANCA, anti-GBM, serologies] (Include only if nephritic/nephrotic differential is active.)

Key Abnormalities: [Brief synthesis of most clinically significant derangements and trends]

Urine Studies

• Specimen Source: [clean catch / catheter / bagged / nephrostomy] and [date/time]
• Urinalysis with Microscopy: [Protein, blood, leukocyte esterase, nitrite, RBC/HPF, WBC/HPF, casts, crystals]
• Protein Quantification: [UPC or UACR with date/time] (Include if relevant.)
• Urine Electrolytes/Osmolality: [Na, K, Cl, urea, osmolality, FENa/FEUrea if used for diagnostic reasoning]
• Culture: [Organism and susceptibilities] (Include if infection suspected.)

(Omit if no urine data available. State "pending" if ordered but not resulted.)

Imaging

• [Date/time — Study type: Key findings and impression] (Prioritize renal/bladder ultrasound: hydronephrosis grade, cortical echogenicity, kidney size, bladder volume/PVR.)
• [Other relevant imaging and urologic interventions with timing]

(Omit if no relevant imaging.)

Assessment

[Concise synthesis in 3–6 sentences] (State presence and severity of AKI if applicable; categorize likely etiology as pre-renal, intrinsic, or post-renal with supporting data; interpret volume status; identify key contributors; highlight immediate risks. Make inferences only when basis is explicitly stated and acknowledge uncertainty. Do not assume baseline kidney function or chronicity without supporting records.)

Recommendations

(Organize as numbered problem list in descending order of severity/urgency. Include only problems relevant to this patient. Clearly distinguish recommendations from actions already completed by nephrology.)

1. [Problem: e.g., AKI / Declining Kidney Function]

• Status/Severity: [Baseline vs current creatinine; urine output status with time window]
• Etiology/Differential: [Pre-renal / intrinsic / post-renal with rationale]
• Diagnostics: [Specific labs, imaging, urine studies and timing]
• Therapeutics: [Fluid strategy tied to volume assessment; diuretics; medication adjustments; nephrotoxin avoidance]
• Monitoring: [What to trend and frequency]
• Contingency: [If X occurs, then Y]

2. [Problem: e.g., Electrolyte/Acid-Base Disorder]

• Status/Trend: [Current value and trajectory; acuity]
• Etiology: [Suspected cause(s)]
• Treatment: [Specific actions with doses/routes; EKG/telemetry if indicated]
• Monitoring: [Frequency of labs and clinical checks]
• Contingency: [Escalation triggers and actions]

3. [Problem: e.g., Hypertension]

• Status: [BP relative to pediatric percentiles; symptoms/end-organ signs]
• Measurement Quality: [Site, position, cuff size; recommended improvements]
• Plan: [Medication regimen with doses and titration; secondary cause evaluation]
• Monitoring: [BP frequency, targets, safety labs]
• Contingency: [Escalation thresholds and rescue therapies]

4. [Problem: e.g., Hydronephrosis / Obstruction]

• Evidence: [Imaging severity; unilateral/bilateral; partial vs complete]
• Status: [Decompression status; urology coordination]
• Monitoring: [Post-obstructive diuresis plan; electrolyte and volume checks]
• Contingency: [If output spikes or hypotension, then fluid/electrolyte strategy]

5. [Problem: e.g., Nephrotoxic Exposure Risk]

• Current Risk: [Active nephrotoxins and cumulative exposure]
• Stewardship: [Alternatives, dosing review, level monitoring]
• Contrast Planning: [Risk mitigation for future imaging if needed]

6. [Problem: e.g., Volume Management]

• Target: [Fluid balance goals]
• Strategy: [Diuretics with dosing; fluid restriction or advancement; nutrition]
• Monitoring: [I/O rigor, daily weights, exam markers]

7. [Problem: e.g., CKD / Transplant / Dialysis]

• Status: [CKD staging; transplant status and trough goals; dialysis modality/access]
• Plan: [Immunosuppression, dialysis prescription, access care]
• Monitoring: [Labs and clinical checks relevant to modality]

(Include only applicable problem sections.)

Action List

• [Action verb] [specific task] — [timing] (Limit to 5–10 high-priority items for primary team. Each item should begin with action verb and include time anchor.)

Communication

• [Date/time] — Discussed recommendations with [requesting clinician name and role] [in-person / by phone]
• [Family/caregiver communication if performed: summary and date/time]

(For urgent or complex recommendations, document that direct verbal communication occurred.)

Follow-Up Plan

• Nephrology follow-up: [daily / PRN with conditions for earlier reassessment]
• Re-contact triggers: [Specific thresholds: creatinine change, UOP, electrolyte values, BP]
• Discharge planning: [Outpatient nephrology follow-up timing, labs, BP monitoring plan, medication changes requiring follow-up]

(Omit if not applicable to initial consult.)