Medicine — Transfer to Nephrology for Worsening CKD
A general physician transfers a 67-year-old man with rapidly worsening CKD Stage 4, new anaemia of CKD, and difficult blood pressure control to the nephrology unit. The transfer letter tests selection: the eGFR trajectory, new complications and the outstanding EPO plan must transfer clearly; the stable comorbidities need only a brief mention.
Letter type
Transfer
Write to
Nephrologist
Target length
180–200 words
The case notes
Patient: Mr James Nguyen, 67 years old, retired engineer
Admission: Admitted via GP with fatigue, dyspnoea on exertion, and declining eGFR on serial bloods
Renal function: eGFR 18 mL/min/1.73m² (down from 32 six months ago); creatinine 318 µmol/L; urea 22.1 mmol/L
Anaemia: Hb 82 g/L (normocytic); ferritin adequate; IV iron commenced; EPO therapy planned but not yet started
Fluid status: Mild fluid overload on admission; furosemide 80 mg daily commenced; peripheral oedema now reduced
Blood pressure: BP 162/96 on admission; amlodipine 10 mg added to existing ramipril 5 mg; BP now 138/84
Urine: Albumin:creatinine ratio 78 mg/mmol; no haematuria; no proteinuria strip change
Medical history: T2DM (HbA1c 64 mmol/mol), hypertension, dyslipidaemia; no previous nephrology review
Medication: Ramipril 5 mg OD, amlodipine 10 mg OD (new), furosemide 80 mg OD (new), metformin held, atorvastatin 40 mg
Task: Write a transfer letter to Dr Priya Singh, Nephrologist, summarising the current clinical status and the outstanding management issues requiring specialist input.
Writing task
Write a transfer letter to Dr Priya Singh, Nephrologist, summarising the current clinical status and the outstanding management issues requiring specialist input.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
-
The eGFR trajectory — 32 six months ago, now 18
Rate of decline is decision-critical for the nephrologist's planning and assessment of dialysis need. The absolute figure alone is less informative than the paired values with the time gap.
-
EPO therapy planned but not yet started
Handover of an incomplete treatment plan is a patient-safety issue. The nephrologist must know this is outstanding so they action it on transfer.
-
Metformin held and BP now controlled with the new agent
Both are management changes made specifically because of the CKD deterioration. The nephrologist needs to know what has changed and what the response was.
Leave out
-
Dyslipidaemia history and atorvastatin narrative
Stable, unchanged, and not related to the acute deterioration. It belongs in the medication list; a narrative sentence adds no decision value for the receiving team.
-
HbA1c detail beyond a brief mention
State it as context — probable diabetic nephropathy — but do not detail the full diabetic management. That is the GP's and endocrinologist's role.
Criterion in focus · Content
Transfer letters are graded on completeness of the active management handover. Any outstanding treatment — such as EPO not yet started — must appear explicitly so the receiving team does not assume it is in place. A letter that implies completion when the task is unfinished is a Content mark failure.
Now write the letter — and find out what is blocking your Grade B
Write a 180–200 words transfer letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.