David Boyle is a 56 year old man, seen as a new patient in the renal clinic. He has been referred by his GP who has been monitoring his U+E and noticed a gradual deterioration over the last 2 years.

You read his referral:

Dear Renal physician,

Thank you for seeing David who has been a patient of our practice for 10 years, but has attended infrequently. Blood tests for an insurance medical 3 years ago showed mild renal impairment with urea 14 and creatinine 160. He had further blood tests a year ago showing creat 210 and last week when we checked his bloods - his creat has climbed to 248.

I would appreciate your assistance in investigation and management of his kidney disease.

Many thanks