Chronic Kidney Disease (CKD)
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Emergency
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.
NB Please call your local Kidney Medicine/Nephrology service if there is any doubt regarding the urgency of referral for an unwell patient
PAEDIATRIC
NB: 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
Haematuria / Glomerular disease
Hypertension
Proteinuria / nephrotic syndromeKidney stones
Other
ADULT
NB: 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
Chronic Kidney Disease (CKD)
Cystic kidney disease
Glomerular Disease
Haematuria
Hypertension
If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.
Nephrolithiasis – recurrent
Proteinuria
Other
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Other useful information for referring practitioners Not and exhaustive list
Minimum Referral Criteria
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Category 1
(appointment within 30 calendar days)- 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 > 220mg/mmol OR PCR > 350g/mol)
NB: eGFR units: mL/min/1.73m2
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Category 2
(appointment within 90 calendar days)- 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
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Category 3
(appointment within 365 calendar days)- 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
Please insert the below information and minimum referral criteria into referral
1. Reason for request Indicate on the referral
- To establish a diagnosis
- For treatment or intervention not otherwise accessible to the patient
- For advice regarding management
- To engage in an ongoing shared care approach between primary and secondary care
- Reassurance for GP/second opinion
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
2. Essential referral information Referral will be returned without this
- 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
3. Additional referral information Useful for processing the referral
- Timeline of symptoms
- Ethnicity (Aboriginal and Torres Strait Islander population especially at risk)
- Iron studies, B12 and folate (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) e.g. FLC, SEPP, urine BJP, PTH
- Family history of kidney disease
- Kidney biopsy report (if available)
4. Request
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General referral information
Patient's Demographic Details
- 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
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
Relevant clinical information about the condition
- 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
Reason for request
- 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
Clinical modifiers
- 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
Other relevant information
- 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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Notes
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Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
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A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
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Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
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