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Hypertension (nephrology)

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

  • Hypertensive emergency (for example BP > 220/140)
  • Severe hypertension with systolic BP > 180mmHg with any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain
    • acute kidney disease
    • suspicion of aortic dissection
    • new neurological deficits

If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.

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

  • Persistent severe hypertension (>180/110 but below 220/140mmHg) or without any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain

Category 2

Appointment within 90 days is desirable

  • Suspected or confirmed renal artery stenosis
  • Patients with resistant hypertension and not achieving blood pressure target despite three or more antihypertensive medications including a diuretic especially in the context of CKD

Category 3

Appointment within 365 days is desirable

  • Patients with uncontrolled hypertension and CKD that are not achieving blood pressure target
  • Hypertension without clear diagnosis, especially in young patients

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
  • Nomenclature has also been redefined by KDIGO and may be worth reassessing

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Presence of comorbid conditions such as hypertension, diabetes or vascular disease
  • List of medications including details of all treatments offered and efficacy
  • Use of OTC (over the counter) medications
  • History of BP measurements including 24-hour measurements or home measurements if available
  • FBC, ELFT & eGFR results
  • 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) or alternative renal imaging results (if available)
  • Renal duplex report (only if renal artery stenosis suspected)

Additional referral information

  • History of smoking, alcohol intake and drug use (including recreational drugs)
  • Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
  • Any investigations relevant to co-morbidities or where results exclude other secondary causes eg sleep study, endocrine tests
  • ECG and echocardiogram results

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.)
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