Acute decline in kidney function
Emergency department referrals
- Urgent cases can be discussed at any time with either the Consultant on call or the Kidney Registrar rostered to the kidney ward (inpatients) can be contacted by ringing the Royal Brisbane and Women's Hospital on (07) 3646 8111.
If any of the following are present
Adult
NB: Please call your local nephrology service if there is any doubt regarding the urgency of referral for an unwell patient
- Any acute kidney injury or significant decline in kidney function where the treating doctor believes the patient requires urgent hospital care (especially if evidence of abrupt increase in serum creatinine by > 50% of baseline)
- Oliguria/anuria
- Severe acute electrolyte disturbance for example:
- hyperkalemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
- hypokalemia with K+ < 2.5 mmol/L OR < 3.0mmol/L with symptoms
- severe metabolic acidosis (HCO3 < 15mmol/L)
- Kidney transplant recipients with an acute decline in kidney function (e.g. > 20% increase in serum creatinine)
- Suspected glomerulonephritis (proteinuria and haematuria) associated with acute kidney injury
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
Abrupt and significant decline in kidney function that does not require referral to emergency but where specialist review is required, for example
- increase in serum creatinine by > 50% of baseline within the last 4 weeks
- increase in serum creatinine by >26.5µmol/L in the last 7 days
Category 2
Appointment within 90 days is desirable
- No Category 2 criteria
Category 3
Appointment within 365 days is desirable
- No Category 3 criteria
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- 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
Other important information for referring practitioners
Not an exhaustive list
- Refer to Healthpathways or local guidelines
- Consider withholding ACE-Inhibitor, ARB, diuretics, NSAIDs, metformin, sulphonylureas, SGLT2 inhibitors
- Consider dose adjustment of medication
Clinician resources
Patient resources
Referral requirements
A referral may be rejected without the following information.
- Presence of comorbid conditions such as hypertension, diabetes or vascular disease
- List of medications
- BP records (if available)
- Serial ELFTs including urea, creatinine & eGFR results
- FBC
- 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)
- Ultrasound (kidney, ureters & bladder) and any other available relevant imaging results
Additional referral information
- Timeline of symptoms
- Presence or absence of oedema
- Other supportive investigative tests indicated including:
- If urine ACR>30mg/mmol or haematuria present with acute decline in kidney function, include ANCA, ANA, ENA & anti DNA Abs, C3/C4 and Hepatitis B/C serology.
- If myeloma suspected, include paraprotein testing eg FLC, SEPP, Urine BJP
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can’t order, or the patient can’t afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- Full name (including aliases)
- Date of birth
- Residential and postal address
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org