Referral to kidney specialist
Emergency referral to on-call nephrologist
Indications for urgent referral to nephrology (including out of hours)
- Acute kidney injury where creatinine is > 3 x above baseline
- Malignant hypertension
- Malignant hyperkalaemia (K >7mmol/L)
- Nephrotic syndrome (uACR >200mg/mmol)
Routine referral to a specialist should be considered and discussed with patients, taking into account their frailty and wishes for the following group of patients:
- a 5-year risk of needing renal replacement therapy of greater than 5% (measured using the 4-variable Kidney Failure Risk Equation)
- an ACR of 70 mg/mmol or more, unless known to be caused by diabetes and already appropriately treated
- an ACR of more than 30 mg/mmol (ACR category A3), together with haematuria
- a sustained decrease in eGFR of 25% or more and a change in eGFR category within 12 months
- a sustained decrease in eGFR of 15 ml/min/1.73m² or more per year
- hypertension that remains poorly controlled (above the person’s individual target) despite the use of at least 4 antihypertensive medicines at therapeutic doses
- known or suspected rare or genetic causes of CKD
- suspected renal artery stenosis