Chronic kidney disease
Adult

Useful Management Information

* At the level of nephrotic range proteinuria, albumin accounts for 60-70% of total urinary protein. Within the CPC, ACR > 300mg/mmol OR PCR > 300g/mol has been used for simplicity and ease of application.

Before waiting 3 months to refer, it is important to establish that there is no evidence of acute kidney injury

In the absence of other referral indicators, referral is not necessary if:

  • Stable eGFR ≥ 30 mL/min/1.73m2
  • Urine ACR < 30 mg/mmol (with no haematuria)
  • Controlled blood pressure

The decision to refer or not must always be individualised, and particularly in younger individuals the indications for referral may be less stringent. Discuss management issues with a specialist by letter, email or telephone in cases where it may not be necessary for the person with CKD to be seen by the specialist.

  • Refer to Healthpathways or local guidelines

Clinician resources

Patient resources

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?
Category 1 (appointment within 30 calendar days)
  • Stage 5 CKD (eGFR < 15) that does not require referral to emergency
  • Stage 4 CKD (eGFR 15 – 29) with any of the following:
    • severe complications (eg renal bone disease, acidosis, hyperkalaemia)
    • symptoms of CKD (eg fatigue, restless legs, itch, weight loss, severe anaemia, mild uremic hyperkalemiasymptoms)
    • multiple contributing comorbidities
    • rapid deterioration
  • Known CKD with severe anaemia (Hb <80g/L)
  • Persistent nephrotic range proteinuria* (urine ACR > 220mg/mmol OR PCR > 350g/mol)

NB: eGFR units: mL/min/1.73m2

Category 2 (appointment within 90 calendar days)
  • Stage 4 CKD (eGFR 15 – 29) that do not meet Category 1 criteria
  • Stage 3a or b CKD with progressive deterioration in eGFR despite treatment (eg deterioration in eGFR >15mL/min/1.73m2 or > 25% over 12 months)
  • CKD with resistant hypertension despite at least three antihypertensive agents including at least one diuretic
Category 3 (appointment within 365 calendar days)
  • Chronic anaemia (Hb 80-100g/L) with CKD Stage 3a or b where other causes have been excluded
  • Persistent sub-nephrotic range macroalbuminuria (urine ACR 30-300mg/mmol OR PCR 60-300g/mol)
  • CKD with uncontrolled hypertension that are not achieving blood pressure target
  • CKD without clear diagnosis
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Essential Referral Information

  • Presence of comorbid conditions such as hypertension, diabetes or vascular disease
  • List of medications
  • FBC & ELFT results
  • Serial urea, creatinine & eGFR results demonstrating abnormal eGFR over at least 3 months
  • Urine albumin creatinine ratio (ACR) or urine protein creatinine ratio (PCR) (ideally early morning sample but a random sample is acceptable)
  • Urine midstream M/C/S (including testing for red cell morphology and casts preferable)
  • Recent BP results
  • Ultrasound (kidney, ureters & bladder) or alternative renal imaging results

Additional Referral Information

  • Timeline of symptoms
  • Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
  • Iron studies (essential if referring for anaemia)
  • Other supportive investigative tests indicated including:
    • If haematuria or macroalbuminurua present, include ANCA, ANA, ENA & anti DNA Abs, C3/C4 and Hepatitis B/C serology
    • If myeloma suspected, include paraprotein testing (especially if proteinuria) eg FLC, SEPP, BJP PTH
    • B12, folate
  • Family history of kidney disease
  • Kidney biopsy report (if available)
Last updated 30 January 2023

Send Referrals To

Related HealthPathways

No directly related pathways found

Service Availability

Facilities

No facilities listed

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

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