Hi, @ryman. Glad to hear from you again, this time on reduced kidney function. Can you think of any reason why your PCP would withhold a referral to a nephrologist? One possibility is that she regards your kidney condition to be a lower priority than your other significant issues. Perhaps your oxygen level is more crucial right now. Another possibility is that she will be more concerned about your kidneys now that she has seen results of this new blood work -- taken two days after your appointment with her. In my own situation, when my blood work suggested more kidney problems than before, I made a note to ask my PCP about it at my next opportunity (which was by email, since that's available at my HMO). I also resolved to ask about a referral to a nephrologist during my next PC appointment -- and got the referral along with some interesting and important perspectives from both doctors. Perhaps your situation could be improved along the same lines as mine was.