Proteinuria
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
- Nephrotic syndrome (proteinuria > 3.5 grams/24 hours OR urine ACR > 300mg/mmol* or PCR > 300g/mol*) with any of the following concerning features:
- significant peripheral oedema
- signs of pulmonary oedema
- severe hypertension
- signs of DVT / PE
- infection
- 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
- Nephrotic range proteinuria* (urine ACR > 220mg/mmol or PCR > 350g/mol) without concerning features (see below)
- Proteinuria (urine ACR 30-220 mg/mmol or PCR 60-350mg/mmol) with a declining eGFR but without concerning features (see below)
Concerning features
- Significant peripheral oedema
- Signs of pulmonary oedema
- Severe hypertension
- Signs of DVT / PE
- Infection
- Acute kidney injury
Please call your local nephrologist if any doubt of urgency of acute referral as direct ward admission may be considered.
Category 2
Appointment within 90 days is desirable
- Sub-nephrotic macroalbuminuria (urine ACR 25-220mg/mmol for men or urine ACR 35-350mg/mmol for women or PCR 60- 350mg/mmol) with a stable eGFR
Category 3
Appointment within 365 days is desirable
- Asymptomatic microalbuminuria (urine ACR < 25mg/mmol for men or < 35mg/mmol for women OR PCR < 50g/mol) with other evidence of kidney disease (eg haematuria)
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.
Quantifying proteinuria (Source – Tasmanian Health 2018):
- Urine ACR (random or first morning) is generally a sufficient screen for albuminuria/microalbuminuria in diabetic and non-diabetic populations and is a useful test in most renal clinic referrals (first morning specimens increase specificity – but not necessary). Additional protein creatinine ratio testing can assist with diagnostic evaluation.
- 24-hour quantification: Where urine ACR is significantly elevated (>100mg/mmol) consideration can be given to 24-hour urine protein collections (not generally required in most low-level albuminuria but is more likely to be helpful in those with suspected nephrotic syndrome)
- Low level albuminuria/proteinuria can occur transiently during fever, cardiac failure, after strenuous exercise (usually no more than trace on dipstick)
- Haematuria and proteinuria present together is strongly suggestive of a glomerular source for haematuria
As per KHA guidelines, persistent significant albuminuria (ACR > 30mg/mmol) should be referred. Referral is not necessary for a urine ACR < 30mg/mmol with no haematuria.
- Refer to Healthpathways or local guidelines
Clinician resources
Patient resources
Referral requirements
A referral may be rejected without the following information.
- Presence of comorbid conditions such as hypertension, diabetes, vascular disease or known chronic kidney disease
- Current medications, medication history and allergies
- Timeline of symptoms
- Examination findings including BP, peripheral oedema, signs of pulmonary oedema
- FBC, ELFT, urea, creatinine & eGFR results (include serial historical results, if available)
- 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)
Additional referral information
- Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
- Fasting lipid results
- HbA1c results (for patients with diabetes)
- Ultrasound (kidney, ureters & bladder) 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.)
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