Chronic Kidney Disease

Referral guidelines

When to refer

This information is for guidance. If in doubt contact the nephrologists for additional advice. In addition most of this advice is for the new CKD patient - previously identified patients should be regularly monitored as suggested in the relevant guidance section. What they may need is an assessment of whether the situation has changed. If previous blood tests are not available it may be prudent (especially for CKD 3 to 5) to recheck the biochemistry within 5 days, to ensure the situation is not deteriorating. Note, referral does not necessarily imply admission is required. If the referral information is detailed, all that may be required is advice.

CKD Stage 5 (previously unrecognised)

This requires urgent referral by telephone, if deemed appropriate. In hours contact either the renal registrar or consultant via the switchboard (01332 340131). Out of hours, contact the on call medical registrar at the Derby City Hospital (via the switchboard). Be prepared to give as much referral information as possible from the data suggested here.

CKD Stage 4 or 5 (currently under nephrology follow up)

Ensure that there are no other urgent indications (e.g. hyperkalaemia). Notify the Renal Service by fax (01332 625975), marked for urgent attention, during working hours. Out of hours consider whether an urgent referral is needed, in which case contact the DCGH on call medical registrar.

CKD Stage 4 (previously unrecognised)

Consider the possibility of acute renal failure and if concerned refer as for stage 5. Arrange repeat biochemistry in 3-5 days. Make nephrology referral, incorporating necessary information (given here).

CKD Stage 3

Follow guidance from CKD 3 page if previously unrecognised and set up monitoring regime as suggested. Referral is indicated if any of the following is present

    Diagnosis unclear (this is especially the case for a person <65 years old)

    Progressive fall in eGFR by > 5% per annum

    Presence of significant proteinuria (greater than 0.5 grams/day)

    Symptoms suggestive of a multi system disease (e.g. SLE, vasculitis) or risk factors for renovascular disease

    Difficult to control blood pressure

CKD Stage 1 and 2

In general patients with an eGFR > 60 mls/min do not normally require nephrological review, but consideration for referral should be given for the following

Diagnosis unclear

    Progressive fall in eGFR by > 5% per annum

    Presence of significant proteinuria

    Symptoms suggestive of a multi system disease (e.g. SLE, vasculitis) or risk factors for renovascular disease

    Difficult to control blood pressure

Other renal problems

Consideration for referral to nephrology may be indicated irrespective of eGFR and CKD stage in the following situations

Nephrotic syndrome - Urgent referral

Malignant hypertension - Urgent referral

Proteinuria > 1 mg/mg (uPCR) or > 100 mg/mmol (note raised ACR up to 30 should be referred according the diabetes guidelines)

Genetic renal disease, e.g. adult polycystic kidney disease, Alports

Information on making a referral

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