Kidney Medicine/Nephrology

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    PAEDIATRIC

    Note: Please call your local Kidney Medicine/Nephrology service if there is any doubt regarding the urgency of referral for an unwell patient


    Congenital anomalies of the kidney and urinary tract

    • Poor urinary stream in neonate / suspected posterior urethral valves
    • Previously undiagnosed kidney impairment in association with congenital structural malformations

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Haematuria / Glomerular disease

    • Suspected glomerulonephritis (i.e. haematuria and proteinuria) with acute kidney injury, hypertension or where the patient is systemically unwell

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Hypertension

    • Suspected acute target organ damage regardless of BP (e.g. acute coronary syndrome, acute heart failure, aortic dissection or aneurysm, acute kidney injury, major neurological changes, hypertensive encephalopathy, papilloedema, acute stroke - haemorrhagic or ischaemic/thromboembolic)
    • Severe hypertension in pregnancy (systolic blood pressure equal to or greater than 140 mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg), including suspected pre-eclampsia refer patient to the emergency department or maternity assessment unit of a facility that offers obstetric services where possible.

    Phaeochromocytoma crisis with sudden severe hypertension
    Proteinuria / nephrotic syndrome

    • Nephrotic syndrome (proteinuria with urine PCR > 200g/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

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Kidney stones

    • Suspected urolithiasis / nephrolithiasis with infection or severe pain
    • Suspected urinary retention/obstruction (eg anuria, oliguria)

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Other

    • Any acute kidney injury or significant decline in kidney function where the treating doctor believes the patient requires urgent hospital care
    • Oliguria/anuria
      • Severe acute electrolyte disturbance for example:
      • hyperkalaemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
      • hypokalaemia 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
    • Suspected glomerulonephritis (proteinuria and haematuria) associated with acute kidney injury

    ADULT

    Note: Please call your local Kidney Medicine/Nephrology service if there is any doubt regarding the urgency of referral for an unwell patient

    Acute decline in kidney function

    • 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:
      • hyperkalaemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
      • hypokalaemia 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

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Chronic Kidney Disease (CKD)

    • Severe acute electrolyte disturbance for example:
      • hyperkalaemia with K+ > 6.5 mmol/L OR > 6.0 mmol/L with ECG changes
      • hypokalaemia 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 (e.g. vascular access issues or peritoneal dialysis catheter issues)
    • Peritoneal dialysis patients with suspected peritonitis (abdominal pain, cloudy dialysis fluid)

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Cystic kidney disease

    • Significant cyst haemorrhage, suspected septicaemia related to cyst infection, suspected rupture of berry aneurysm

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Glomerular Disease

    • Suspected Glomerular Disease (proteinuria and haematuria) with acutely declining kidney function or patient systemically unwell

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Haematuria

    • Severe macroscopic haematuria

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Hypertension

    • Suspected acute target organ damage regardless of BP (e.g. acute coronary syndrome, acute heart failure, aortic dissection or aneurysm, acute kidney injury, major neurological changes, hypertensive encephalopathy, papilloedema, acute stroke - haemorrhagic or ischaemic/thromboembolic)
    • Severe hypertension in pregnancy (systolic blood pressure equal to or greater than 140 mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg), including suspected pre-eclampsia refer patient to the emergency department or maternity assessment unit of a facility that offers obstetric services where possible.
    • Phaeochromocytoma crisis with sudden severe hypertension

    Nephrolithiasis – recurrent

    • Suspected urolithiasis / nephrolithiasis with infection or severe pain
    • Suspected urinary retention/obstruction (e.g. anuria, oliguria)

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Proteinuria

    • Nephrotic syndrome (proteinuria> 3.5 grams/24 hours OR urine ACR > 220mg/mmol* or PCR > 300mg/mmol*) with any of the following concerning features:
      • significant peripheral oedema
      • signs of pulmonary oedema
      • severe hypertension
      • signs of DVT / PE
      • infection
      • acute kidney injury

    *At the level of nephrotic range proteinuria, albumin accounts for 60-70% of total urinary protein. Within the CPC, ACR > 220mg/mmol OR PCR > 300mg/mmol has been used for simplicity and ease of application.

    Note: If there is any uncertainty regarding the urgency of referral for an unwell patient, please contact your local Kidney Medicine service for guidance.

    Other

    • Kidney transplant patients with significant intercurrent illness (e.g. diarrhoea and vomiting)

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Kidney Medicine/Nephrology service.

Last updated: 25 November 2025

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