Chronic kidney disease

Emergency 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

NB: Please call your local nephrology service if there is any doubt regarding the urgency of referral for an unwell patient

  • 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)
  • Severe hypertension especially when accompanied with declining kidney function
  • Patients with severe uraemic symptoms or signs
  • Evidence of acute fluid overload or heart failure in a patient with known CKD
  • Kidney transplant recipients with acute intercurrent illness
  • Peritoneal or haemodialysis patients with acute issues or problems with dialysis access (eg vascular access issues or peritoneal dialysis catheter issues)
  • Peritoneal dialysis patients with suspected peritonitis (abdominal pain, cloudy dialysis fluid)

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

  • 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 symptoms)
    • multiple contributing comorbidities
    • rapid deterioration
  • Known CKD with severe anaemia (Hb <80g/L)
  • Persistent nephrotic range proteinuria* (urine ACR > 2200mg/mmol OR PCR 350g/mol >

NB: eGFR units: mL/min/1.73m2

Category 2

Appointment within 90 days is desirable

  • 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 days is desirable

  • 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 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

* 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.

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
  • 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)
  • 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

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

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