Workflow: Summarising a Complex Nephrology Case for Referral

Complex nephrology cases — patients being referred for transplant assessment, those with uncertain diagnoses requiring second opinion, or patients approaching end-stage renal disease with multiple comorbidities — require clinical summaries that tell a complete story in a structured, readable format. This workflow produces that summary.

1. Read the case before you start

   Before giving the tool anything to work with, read the case yourself. You need to understand the clinical narrative — the original diagnosis, the treatment history, the trajectory, and the specific question being referred. The tool can only organise what you give it. You decide what matters.

2. Write an anonymised chronological summary

   On a blank document, write the key clinical events in order: first presentation, diagnosis, investigations performed and their results, treatments, disease progression, comorbidities, complications, and current status. Use age range rather than exact age. Remove all identifying information. This is your source material.

3. Identify the specific referral question

   Before opening the tool, write one sentence describing the specific question for the receiving service. A transplant referral asks a different question from a second opinion about diagnosis. A question about dialysis timing is different from a question about a specific management decision. The clearer the question, the more focused the summary.

4. Open the tool and specify the format

   Open your AI tool and type: "I am a nephrologist preparing a structured clinical referral summary. I will give you anonymised clinical bullet points. Organise them into a structured summary with these headings: Diagnosis and Clinical Background, Renal History, Investigations, Current Management, Current Status, Referral Question. Do not add any clinical information I have not provided. Do not include clinical recommendations."

5. Provide your anonymised bullet points

   Paste your clinical notes. The tool will produce a structured summary. Review it against your source material for accuracy.

6. Check the renal history section carefully

   For complex nephrology cases, the renal history is the most critical section. Check that: the progression of kidney function over time is accurately described, prior biopsies and their findings are correctly reported, prior treatments are accurately listed, and the timeline is correct. Any error in this section misrepresents the clinical story to the receiving team.

7. Sharpen the referral question

   If the tool's version of the referral question is too general, ask it to help you phrase it more specifically: "Rewrite the Referral Question as a specific, focused clinical question based on this case. Offer two formulations." Review and select the one that best matches your clinical intent. Add any context the tool has missed.

8. Add a current medications section

   The tool cannot generate an accurate medications list. Ask it to add a placeholder section: "Current Medications: [to be added by clinician from current prescription]." Then complete this yourself from the current medication record before sending.

What this means for you

A well-structured referral summary allows the receiving transplant team, second opinion consultant, or MDT to engage with the clinical question immediately. They can see the diagnosis, the trajectory, and the question without reading through years of clinic letters. The tool compresses the structural work. Your clinical expertise determines what goes in.

When not to use this workflow

For transplant referrals, check that the transplant centre has specific referral requirements beyond a standard clinical summary. Many transplant centres have structured referral proformas that should be completed in addition to or instead of a free-text summary. Use this workflow to prepare the clinical narrative, then transfer the key content into the required format.

Remember: AI is a helpful assistant, not a clinician. You make the call.