Last reviewed by Dr. Leena Joshi, MD, August 2026
You should see a nephrologist when your primary care doctor refers you, usually because a routine blood or urine test shows an eGFR under 60 on more than one test, protein or blood in the urine, high blood pressure that resists two or more medications, repeated kidney stones, or an electrolyte problem that will not correct. Dr. Leena Joshi, MD is a board-certified nephrologist in Burlingame and Daly City who sees new patients typically within days of referral. Call (650) 355-5551.
What lab results mean it is time to see a nephrologist?
- eGFR under 60 on two tests at least three months apart (this defines chronic kidney disease stage 3 or worse), or an eGFR falling faster than expected year over year
- Albumin or protein in the urine: a urine albumin-to-creatinine ratio (ACR) of 30 mg/g or higher, or protein on a dipstick that persists
- Blood in the urine that is not explained by infection or stones
- Rising creatinine or BUN without a clear short-term cause
- Persistent electrolyte problems such as high potassium or low sodium
Which conditions usually lead to a referral?
- Diabetes with any sign of kidney involvement
- High blood pressure that stays high despite two or more medications
- Repeated kidney stones, or a first stone with kidney disease or a metabolic condition
- Family history of kidney disease, such as polycystic kidney disease
- Autoimmune disease affecting the kidneys, such as lupus
What symptoms should prompt a kidney evaluation?
- Swelling in the legs, ankles, feet, face, or hands
- Foamy urine, dark or bloody urine, or a change in how often you urinate
- Persistent fatigue, trouble concentrating, or shortness of breath
- Nausea, poor appetite, or a metallic taste
- Muscle cramps or itching that will not resolve
What does a nephrologist do that a primary care doctor does not?
A nephrologist looks for the cause of kidney damage, not just the number. Dr. Joshi’s evaluation covers medication review for kidney safety, urine studies that identify the type of kidney disease, imaging review, and when needed, coordination of a kidney biopsy. She then builds a plan to slow the disease: blood pressure and blood sugar targets, kidney-protective medicines, diet matched to your labs, and a monitoring schedule. If kidney function is very low, she plans dialysis or transplant well in advance. Nephrologists do not perform surgery; stones that need removal are handled with a urologist.
What happens at the first appointment?
Expect a full history, a review of your labs and medications, a physical exam, and often new blood and urine tests. Dr. Joshi explains your kidney function in plain language, tells you what she thinks is causing it, and sets the plan and the follow-up interval before you leave. Bring recent results, your medication list, and any home blood pressure readings.
Related reading: kidney lab results explained, what to expect at your first nephrology appointment, and chronic kidney disease treatment.
Frequently asked questions
What does a nephrologist do?
A nephrologist is a physician who specializes in kidney disease. Dr. Joshi diagnoses the cause of kidney problems, slows kidney disease, manages high blood pressure and electrolyte disorders, treats conditions such as diabetic kidney disease, kidney stones, and lupus nephritis, and plans dialysis or transplant when needed. Nephrologists do not operate; that is a urologist’s role.
Can my primary care doctor treat kidney disease?
Yes, especially early on. Your primary care doctor screens for kidney disease and manages the basics. A nephrologist is added when the numbers cross a threshold, decline quickly, or the cause is unclear.
Do I need a referral to see Dr. Joshi?
Yes. A referral is always required to see a nephrologist. Once it arrives, appointments are typically available within days at the Burlingame or Daly City office.
What should I bring to my first nephrology appointment?
Recent blood and urine results, a list of all medications and supplements, your blood pressure readings if you track them, and any imaging reports. Dr. Joshi will also want your family history of kidney disease.
Will I still see my primary care doctor?
Yes. Dr. Joshi works alongside your primary care doctor and any other specialists. She sends notes after each visit so everyone works from one plan.
Does seeing a nephrologist mean I need dialysis?
No. Most patients referred to a nephrologist never need dialysis. The point of an early referral is to prevent that.
Does Dr. Joshi treat children?
No. Dr. Joshi is an adult nephrologist. Children with kidney problems are seen by a pediatric nephrologist.
Schedule an appointment
Dr. Leena Joshi, MD is a board-certified nephrologist with offices at 1750 El Camino Real, Suite 301, Burlingame and 1800 Sullivan Ave, Suite 507, Daly City. New patient appointments are typically available within days. A referral from your doctor is required; visits are by appointment only. Call (650) 355-5551.
This page is for general education and is not a substitute for medical advice. Always consult your physician about your specific situation.
Medically reviewed by Leena Joshi, MD.