CHRONIC KIDNEY DISEASE REFERRAL

Who may be considered for referral to a nephrologist ?

Anyone with:

• eGFR < 30mL/min/1.73m2

• Unexplained decline in kidney function (> 15% drop in eGFR over three months)

• Proteinuria > 1g/24hrs (see clinical tip)

• Glomerular haematuria (particularly if proteinuria present)

• CKD and hypertension that is hard to get to target

• Diabetes with eGFR < 60mL/min/1.73m2

• Unexplained anaemia (Hb < 100 g/L) with eGFR < 60mL/min/1.73m2

Clinical tip:

• Urine protein:creatinine ratio of 100 mg/mmol = daily protein excretion of 1g/24hrs.
• Anyone with an acute presentation and signs of acute nephritis should be regarded as a medical emergency and referred without delay.
  

Who does not usually need to be referred to a nephrologist ?

CKD Stage 2 and 3

• Stable eGFR 30–89 mL/min/1.73m2

• Minor proteinuria (< 0.5 g/24hrs with no haematuria)

• Controlled blood pressure

• Don’t refer to nephrologist if targets of therapy are achieved

• Pay attention to CVD risk reduction

• Use ACE inhibitors/ARBs

• Monitor three to six monthly

The decision to refer or not must always be individualised, and particularly in younger patients the indications for referral may be less stringent (e.g. minor proteinuria).

Clinical tip:

• When referring to a nephrologist, ensure patient has had a recent kidney ultrasound, current blood chemistry, and quantification of proteinuria.

Source: www.kidney.org.au Nov 2007