Nutrient enrichment has degraded many of the world’s estuaries by amplifying algal production, leading to hypoxia/anoxia, loss of vascular plants and fish/shellfish habitat, and expansion of harmful blooms (HABs). Policies to protect coastal waters from the effects of nutrient enrichment require information to determine if a water body is impaired by nutrients and if regulatory actions are required. We compiled information to inform these decisions for San Francisco Bay (SFB), an urban estuary where the best path toward nutrient management is not yet clear. Our results show that SFB has high nutrient loadings, primarily from municipal wastewater; there is potential for high algal production, but that production is not fully realized; and SFB is not impaired by hypoxia or recurrent HABs. However, our assessment includes reasons for concern: nitrogen and phosphorus concentrations higher than those in other estuaries impaired by nutrient pollution, chronic presences of multiple algal toxins, a recent increase of primary production, and projected future hydroclimatic conditions that could increase the magnitude and frequency of algal blooms. Policymakers thus face the challenge of determining the appropriate protective policy for SFB. We identify three crucial next steps for meeting this challenge: (1) new research to determine if algal toxins can be reduced through nutrient management, (2) establish management goals as numeric targets, and (3) determine the magnitude of nutrient load reduction required to meet those targets. Our case study illustrates how scientific information can be acquired and communicated to inform policymakers about the status of nutrient pollution, its risks, and strategies for minimizing those risks.