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OET Medicine · Referral Letter

Medicine Referral Letter: Chronic Kidney Disease to Nephrology

A GP refers a patient with declining kidney function, diabetes and hypertension to a nephrologist for assessment.

Task

Using the information in the case notes, write a letter of referral to Dr Priya Nair, Consultant Nephrologist, requesting assessment and management advice.

Case notes

  • Mr Daniel Okafor, 62, type 2 diabetes for 12 years; hypertension for 8 years.
  • eGFR trend: 58 (2024) → 49 (2025) → 41 mL/min/1.73m² (this month). Urine albumin:creatinine ratio 48 mg/mmol.
  • BP today 152/94 despite ramipril 10 mg daily and amlodipine 10 mg daily.
  • HbA1c 62 mmol/mol on metformin 1 g twice daily (dose reduced from today due to eGFR) and gliclazide.
  • Potassium 5.4 mmol/L. Ankle swelling mild; no breathlessness.
  • Ex-smoker. Works as a taxi driver. Annual flu vaccination up to date. Knee pain treated with physiotherapy last year.

Try it yourself first: five minutes to plan, 40 minutes to write, 180–200 words in the body of the letter.

Model answer

Dr Priya Nair
Consultant Nephrologist
Renal Outpatient Clinic, City General Hospital
6 October 2026
Re: Mr Daniel Okafor, aged 62
Dear Dr Nair, I am writing to refer Mr Daniel Okafor, a 62-year-old man with type 2 diabetes and hypertension, whose kidney function has declined steadily over the past two years. I would be grateful for your assessment and advice regarding his further management. His eGFR has fallen from 58 in 2024 to 49 last year and 41 mL/min/1.73m² this month. His urine albumin:creatinine ratio is raised at 48 mg/mmol, and his potassium is 5.4 mmol/L. On examination, he has mild ankle swelling; however, he reports no breathlessness. He is an ex-smoker. Mr Okafor's blood pressure remains elevated at 152/94 despite ramipril 10 mg and amlodipine 10 mg daily. His diabetes is suboptimally controlled, with an HbA1c of 62 mmol/mol on gliclazide and metformin; I have reduced his metformin dose today in view of his renal function. In particular, I would welcome your advice on achieving better blood pressure control in the context of his raised potassium, and on whether additional renoprotective treatment would be appropriate for him. Thank you for seeing this patient. Please do not hesitate to contact me if you require further information. Yours sincerely, Dr Sarah Klein General Practitioner

Body word count: 183 (target 180–200, excluding the address, date, salutation and sign-off).

Why this letter works

Purpose

States the problem (declining kidney function) and the request (assessment and management advice) in the opening, then sharpens it into two specific questions at the end.

Content

The eGFR trend is given as a trend, not a list — that is what a nephrologist needs to judge progression. Potassium is included because it constrains treatment.

Conciseness & Clarity

Vaccination, occupation and resolved knee pain are left out.

Genre & Style

Doctor-to-specialist register; standard units and accepted abbreviations (eGFR, HbA1c) are appropriate for this reader.

Language

Accurate tense control: past decline (“has fallen”), current state (“remains elevated”), action today (“I have reduced”).

What was left out — and why

  • Vaccination status and unrelated past knee pain.
  • Occupation, which has no bearing on the referral question.

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