Nephrology

Renal medicine referral

If there is a concern about the delay of the appointment, or any deterioration in the patient’s

Eligibility

At least one must be met for the patient to be eligible for referral.

Patients who are being treated for the same condition at another Victorian public hospital

Children under 18 years of age

Urinary obstruction, renal colic (refer to Urology)

Uncomplicated kidney stones Exceptions are recurrent/complex stones requiring metabolic evaluation for underlying cause

Renal masses requiring evaluation to exclude malignancy (refer to Urology) Exception is suspected polycystic kidney disease (refer to Renal)

eGFR < 30ml/min/1.73m2

Rapid decline in eGFR (>25% or > 15ml/min/1.73m2 in 12months)

persistent urine ACR >30mg/mmol (after commencing stepwise therapy e.g. ACE

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Major metabolic disturbance (hyperkalaemia)

Acute kidney injury: rapid decline in eGFR (> 25% in days-weeks)

Routine referral criteria

Determine Category 2 or 3 urgency.

Initial primary-care work-up complete (history, examination, baseline investigations per Alfred guideline)

Symptoms persist or progress despite primary-care management

Usually managed in primary care

Patients who are being treated for the same condition at another Victorian public hospital
Children under 18 years of age
Urinary obstruction, renal colic (refer to Urology)
Uncomplicated kidney stones Exceptions are recurrent/complex stones requiring metabolic evaluation for underlying cause
Renal masses requiring evaluation to exclude malignancy (refer to Urology) Exception is suspected polycystic kidney disease (refer to Renal)
eGFR < 30ml/min/1.73m2
Rapid decline in eGFR (>25% or > 15ml/min/1.73m2 in 12months)
persistent urine ACR >30mg/mmol (after commencing stepwise therapy e.g. ACE inhibitor/ARB, SGLT2 inhibitor as outlined in CKD Management in Primary Care handbook
Uncontrolled hypertension despite 3 or more medications at therapeutic doses
Haematuria
Suspected polycystic kidney disease or other genetic kidney disorder
Suspected glomerulonephritis
Patients with CKD at high risk of progression will routinely have ongoing follow up in Renal outpatient clinics
Patients evaluated by the Renal service with low risk of progression will commonly be discharged to the referring doctor after 1-2 appointments with a management plan including criteria for re-referral
Refer to the full Alfred Health PDF guideline for complete inclusion / exclusion criteria, required investigations and triage categories.